Conversion from Sleeve Gastrectomy to Ring-augmented Roux-en-Y Gastric Bypass

A study published in BMC Surgery suggests that conversion from sleeve gastrectomy to ring-augmented Roux-en-Y gastric bypass is safe and effective for weight loss.

Background

Weight recurrence, suboptimal clinical response, and functional disorders (such as reflux) after a Sleeve Gastrectomy (SG) are problems that may require conversional surgery. For reflux, conversion to Roux-en-Y Gastric Bypass (RYGB) is considered effective. Regarding treatment for suboptimal clinical response, the technique of choice remains a subject of debate.

Study Aim

This study aims to evaluate the safety and effectiveness of conversion from SG to Ring-augmented RYGB (RaRYGB). All laparoscopic SG to RaRYGB conversions performed between January 2016 and January 2022 were included. The primary outcome was percentage total weight loss (%TWL) after 1-year follow-up.

Secondary Outcomes

• Cumulative %TWL
• Complications (with a focus on ring-related complications)
• Resolution of medical-associated problems

Results

They included 50 patients of whom 44 were female. Mean pre-conversion BMI was 37.6 kg/m². All patients have reached the 1-year follow-up point, however, 10 were lost to follow-up. After 1-year, mean TWL was 17.8% while mean cumulative TWL, calculated from primary SG, was 32%. A total of 10 complications occurred in 8 patients within 30 days, 6 of which were ≤ CD3a and 4 ≥ CD3b.

One MiniMizer was removed for complaints of severe dysphagia. Of the 35 medical-associated problems present at screening, 5 remained unchanged (14.2%), 15 improved (42.9%), and 15 achieved remission (42.9%). The series of 50 patients undergoing conversion from SG to RaRYGB is adequate and successful regarding additional weight loss 1 year after conversion, cumulative weight loss, complication rate, and achievement of improvement or remission of medical-associated problems.

Reference

van Dam, K.A.M., de Witte, E., Broos, P.P.H.L. et al. Short-term safety and effectiveness of conversion from sleeve gastrectomy to Ring-augmented Roux-en-Y gastric bypass. BMC Surg 24, 266 (2024). https://doi.org/10.1186/s12893-024-02552-7