Reasons and outcomes of conversion of laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass for nonresponders

Background: Laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure has gained significant popularity. Conversion to Roux-en-Y gastric bypass (RYGBP) or Roux-en-Y esophagojejunostomy (LRYEJ) has been described as a treatment option for inadequate weight loss after LSG and unresolved co-morbidities or complications such as leak, stricture, and severe gastroesophageal reflux disease (GERD).

Objectives: To determine reasons and outcomes of conversions of LSG to RYGBP.

Setting: Academic Center of Excellence

Methods: Between January 2004 and August 2014, a total of 1118 patients underwent primary LSG for morbid obesity. A retrospective review of a prospectively collected database was conducted for laparoscopic conversions of LSG to RYGBP or LRYEJ, describing reasons and outcomes.

Results: Conversion to RYGBP was identified in 30 (2.7%) patients, of whom only 9 (0.8%) were originally from the authors' institution. Of the entire cohort of revisions, 9 (0.8%) had intractable GERD; only 4 (0.4% of total LSGs reviewed) were originally from the authors' institution. Seven (0.6%) patients were revised for inadequate weight loss: 5 (0.4%) originally from the authors' institution, 2 (0.2%) for stricture, and 12 (1.1%) for leak. Both the stricture and the leak patients were referred from outside institutions. All procedures were performed laparoscopically. The additional mean excess weight loss after conversion to RYGBP was 30.9% with no mortalities.

Conclusions: The most common reason for conversion was chronic leak. The conversion rate of LSG to RYGBP due to inadequate weight loss, GERD, and stricture was 1.6% for the entire group, with .8% from the authors' institution. Additional follow-up and studies are needed to define real incidence of GERD after LSG.