IBC-Oxford University2023_BJSOral_22Long Term Results of Conversion of Failed Laparoscopic Sleeve Gastrectomy into Four Different Bariatric Procedures, with a Follow-up of up to 14 Years
Authors: El-On R , Sirhan S , Petriuk Y , Nevo N , Rayman S , Keidar A 
Published: December 2023

Abstract

Background
Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric operation. Its main downside is the high long term weight loss failure, necessitating re-operation and conversion. The optimal conversion technique is yet unknown, and reported long term data after conversion is lacking. Here we report the long-term results of our experience with conversion of failed LSG to four different bariatric procedures, laparoscopic Roux-Y Gastric Bypass (RYGB), laparoscopic Duodenal Switch (LDS), laparoscopic One Anastomosis Gastric Bypass (OAGB), and laparoscopic Single Anastomosis Duodeno-Ileal Bypass (SADIS), with a follow up of up to 14 years.

Methods
We analyzed data from 160 conversion procedures done for failed LSG, between the years 2007 to 2023. The procedure selection has changed over time, but the indication for conversion for weight related reasons was the same (BMI ≥34 kg/m²). Most patients were operated for weight loss failure. Patients operated for early strictures, stenosis and early dysfunction were excluded from the weight analysis. In almost all cases where sleeve dilatation was encountered, re-sleeve or pouch trimming were performed. The subgroup of patients with a follow up longer than 5 years was analyzed separately, to produce the long-term data.

Results
All operations were done laparoscopically, 6 patients suffered postoperative complications, no perioperative deaths were reported. Three patients required a corrective procedure due to severe malabsorption, from the LDS group.
RYGB: 58 patients underwent conversion to RYGB, of those, 31 patients had pre-conversion BMI of ≥34kg/m², with a mean BMI of 40.4±5.5kg/m² and mean excess weight before conversion was 40.6kg. After a mean follow up of 7.7 years, mean BMI, excess weight loss and mean total weight loss were 32.8±5.3kg/m², 50.35%, and 18.1%, respectively. Long-term follow up (mean 9.2 years) of 23 patients, revealed mean BMI, excess weight loss and mean total weight loss were of 33±5.6kg/m², 52.1% and 19.24%, respectively.
LDS: 20 patients underwent conversion to DS, all had pre-conversion BMI of ≥34kg/m², with a mean BMI of46.48±6.8kg/m², their mean excess weight before conversion was 59.22kg. After a mean follow up of 8 years, mean BMI, excess weight loss and mean total weight loss were 31.4±5.6kg/m², 71.6% and 31.9%, respectively. Long-term follow up (9.3 years) of 15 patients showed a mean BMI, excess weight loss and mean total weight loss were BMI of 30.9±5.1kg/m², 73.9%, 33.8%, respectively. Mean bowel movements per day was 3.2.
OAGB: 45 patients underwent conversion to OAGB, of those, 39 patients had pre-conversion BMI of ≥34kg/m², with a mean BMI of 40±3.2kg/m², their mean excess weight before conversion was 42.2kg. After a mean follow-up of 2.4 years, mean BMI, excess weight loss and mean total weight loss were 30.4±5.5kg/m², 65.18%, 23.9%, respectively. Long-term follow up (6 years) of 9 patients showed mean BMI, excess weight loss and mean total weight loss of 27.1±4.3kg/m, 84.5% and 30%, respectively. Mean bowel movements per day was 3.2.
SADI-S: 37 patients underwent conversion to SADI-S, all patients had pre-conversion BMI of ≥34kg/m², with a mean BMI of 43.2±7kg/m², their mean excess weight before conversion was 52.6kg. After a mean follow up of 1.2 years, mean BMI, excess weight loss and mean total weight loss were 28.7±5.5kg/m², 78.5%, and 32.2%, respectively. The mean bowel movements per day was 4. Long-term follow up for these patients is underway.

Conclusion
Conversion of failed LSG to either RYGB, DS, MGB or SADI-S, are all safe and feasible options without significant perioperative complications. Even with different preoperative characteristics of the groups (intrinsic to all non-randomized studies) our long-term results suggest for weight loss failure or weight regain stronger malabsorptive procedures produce a better long term weight loss, comparatively to RYGB. Long-term results after conversion to SADI are still pending and may seem as a very effective conversion technique.