Outcomes of reoperative surgery in severely obese patients after sleeve gastrectomy: a single-institution experience.
Bariatric Surgery
Complications
Conversions
Obesity
Surgical outcomes
Journal
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
ISSN: 1878-7533
Titre abrégé: Surg Obes Relat Dis
Pays: United States
ID NLM: 101233161
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
received:
04
11
2019
revised:
10
04
2020
accepted:
16
04
2020
pubmed:
9
6
2020
medline:
28
4
2021
entrez:
9
6
2020
Statut:
ppublish
Résumé
Despite its popularity, sleeve gastrectomy (SG) is not devoid of postoperative complications and weight regain. Some of these cases warrant conversion to Roux-en-Y gastric bypass or proximal gastrectomy with Roux-en-Y esophagojejunostomy. Complications after conversion are scarcely reported in the literature. Report and review the outcomes of reoperation on severely obese patients with weight regain or complications after SG. Bariatric Surgery Center of Excellence; Community Hospital, United States. We retrospectively reviewed the medical records of patients converted from SG to Roux-en-Y gastric bypass/proximal gastrectomy with Roux-en-Y esophagojejunostomy at our center, from 2004 to 2018. Patients were stratified by reason for conversion. Group A included those converted for complications (leaks, strictures, or gastroesophageal reflux disease) and group B for reported weight regain. Demographic characteristics, postoperative outcomes, and complications were described. From 77 conversions identified, 63.6% (n = 49) underwent primary SG at an outside hospital. We observed predominant female (68.8%; n = 53) and Caucasian (76.6%; n = 59) populations. Conversions for complications were performed in 67.5% (n = 52) and for weight regain in 32.4% (n = 25). The most common conversion indication in group A was chronic leak (29.9%; n = 23), followed by gastroesophageal reflux disease (20.8%; n = 16), and stricture (16.9%; n = 13). Overall, major complications occurred in 16.9% (n = 13) and minor complications in 19.4% (n = 15). In group A, most common major complications were anastomotic leak and organ space surgical site infection (3.9%; n = 2 each); the most common minor complication was nonperforated marginal ulcer (7.7%; n = 4). In group B, the most common major complication was perforated marginal ulcer (8%; n = 2); the most common minor complication was stricture (16%; n = 4). Group B mean preconversion body mass index was 38.4 ± 4.3 and percentage excess body mass index loss was 48 ± 33, 63 ± 45, 59 ± 63, and 73 ± 25 (12, 24, 36, ≥48 mo). Our experience shows that major complications can occur in up to 17% of patients after conversion. Conversion to Roux-en-Y gastric bypass in nonresponders appears to be a safe and effective option for body mass index reduction.
Sections du résumé
BACKGROUND
BACKGROUND
Despite its popularity, sleeve gastrectomy (SG) is not devoid of postoperative complications and weight regain. Some of these cases warrant conversion to Roux-en-Y gastric bypass or proximal gastrectomy with Roux-en-Y esophagojejunostomy. Complications after conversion are scarcely reported in the literature.
OBJECTIVES
OBJECTIVE
Report and review the outcomes of reoperation on severely obese patients with weight regain or complications after SG.
SETTING
METHODS
Bariatric Surgery Center of Excellence; Community Hospital, United States.
METHODS
METHODS
We retrospectively reviewed the medical records of patients converted from SG to Roux-en-Y gastric bypass/proximal gastrectomy with Roux-en-Y esophagojejunostomy at our center, from 2004 to 2018. Patients were stratified by reason for conversion. Group A included those converted for complications (leaks, strictures, or gastroesophageal reflux disease) and group B for reported weight regain. Demographic characteristics, postoperative outcomes, and complications were described.
RESULTS
RESULTS
From 77 conversions identified, 63.6% (n = 49) underwent primary SG at an outside hospital. We observed predominant female (68.8%; n = 53) and Caucasian (76.6%; n = 59) populations. Conversions for complications were performed in 67.5% (n = 52) and for weight regain in 32.4% (n = 25). The most common conversion indication in group A was chronic leak (29.9%; n = 23), followed by gastroesophageal reflux disease (20.8%; n = 16), and stricture (16.9%; n = 13). Overall, major complications occurred in 16.9% (n = 13) and minor complications in 19.4% (n = 15). In group A, most common major complications were anastomotic leak and organ space surgical site infection (3.9%; n = 2 each); the most common minor complication was nonperforated marginal ulcer (7.7%; n = 4). In group B, the most common major complication was perforated marginal ulcer (8%; n = 2); the most common minor complication was stricture (16%; n = 4). Group B mean preconversion body mass index was 38.4 ± 4.3 and percentage excess body mass index loss was 48 ± 33, 63 ± 45, 59 ± 63, and 73 ± 25 (12, 24, 36, ≥48 mo).
CONCLUSIONS
CONCLUSIONS
Our experience shows that major complications can occur in up to 17% of patients after conversion. Conversion to Roux-en-Y gastric bypass in nonresponders appears to be a safe and effective option for body mass index reduction.
Identifiants
pubmed: 32507733
pii: S1550-7289(20)30241-0
doi: 10.1016/j.soard.2020.04.036
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
983-990Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.