Mid-term Results of Laparoscopic Conversion of Gastric Bypass to Duodenal Switch for Weight Regain: the Review of the Literature and Single-Center Experience.

BACKGROUND

Weight regain after Roux-en-Y gastric bypass (RYGB) is a nightmare for the patients and the surgeons and is mostly regarded as "irreversible." However, conversions to duodenal switch (DS) have been done previously with promising success. The current paper reports a single center's mid-to-long-term follow-up outcomes.

METHODS

The data from all patients undergoing a conversion of RYGB (and one anastomosis gastric bypass (OAGB)) to DS were reviewed retrospectively. The demographic, operative, and weight loss parameters were analyzed, including age, duration of surgery, weight loss, body mass index (BMI), and morbidity/mortality.

RESULTS

Seventeen patients were operated on between January 2013 and December 2021. The mean BMI was 45 kg/m2 (33-70) before conversion. The overall average %EWL was 74.4%, the least was 52% at 6 months, and the most was 91% at 24 and 36 months. All comorbidities resolved after conversion. One patient had a gastro-gastrostomy leak needing prompt surgical repair on the same day of diagnosis. Three patients had other complications: a duodenal stump leak, an intrabdominal abscess, and an ileus. All resolved without surgery. One sudden death happened on the 5th postoperative day.

CONCLUSION

Laparoscopic conversion of gastric bypass operations to DS is a complicated procedure that may have severe complications despite excessive patience and expertise but can be performed in a single step. The mid-to-long-term outcomes are promising for weight loss and control of associated co-morbidities.