The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
Department of Surgery, Samson Assuta Ashdod Public Hospital, Affiliated with Ben-Gurion University of the Negev, Ashdod, Israel.
Surg Obes Relat Dis. 2024 Dec;20(12):1279-1287. doi: 10.1016/j.soard.2024.08.021. Epub 2024 Aug 19.
Failed sleeve gastrectomy (SG), defined by inadequate weight loss or weight regain and by reflux and structural complications, can be treated by a laparoscopic conversion to Roux-en-Y gastric bypass (RYGB).
To examine the efficacy and outcomes of conversion surgery over a 14-year follow-up period.
Government and private medical centers in university settings.
We conducted a cohort study of 58 patients who underwent conversion of SG to RYGB for 2 indications: invalidating reflux or weight recurrence during 2009-2023. Weight dynamics analysis was performed with 2 references of weight: before SG (with intention to treat) and before conversion.
At conversion surgery, the mean weight, body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of total weight loss (%TWL) (calculated with intention to treat, from the weight before SG) were 92.2 ± 25.2 kg, 34.3 ± 8.0 kg/m, 55.2% ± 39.9%, and 22.8% ± 15.2%, respectively. Mean nadir weight, BMI, %EWL, and %TWL after conversion (calculated from the weight before SG) were 71.1 ± 18.4 kg, 26.7 ± 5.5 kg/m, 96.5% ± 30.5%, and 40.2% ± 10.6%, respectively. At follow-up, the mean weight, BMI, %EWL, and %TWL (calculated from the weight before SG) were 80.4 ± 17.7 kg, 29.6 ± 5.4 kg/m, 78.9% ± 26.8%, and 33.3% ± 11.2%, respectively. The mean percentages of %EWLio and %TWLio (calculated from the weight before conversion = EWL from index operation) at nadir were 73.2% ± 92.7% and 20.1% ± 12.2% after conversion, respectively, and decreased to 41.9% ± 94.0% and 13.2% ± 15.2% at last follow-up (mean 6.6 yr), respectively.
SG to RYGB conversion provides moderate to low complementary weight loss in the short term. By 3-4 years, there is a clear trend toward weight gain.
Sleeve gastrectomy（SG）失败的定义为减重不足或体重反弹，以及反流和结构并发症，可以通过腹腔镜转换为 Roux-en-Y 胃旁路术（RYGB）进行治疗。
在 14 年的随访期间，检查转换手术的疗效和结果。
大学附属医院的政府和私人医疗中心。
我们对 58 例因反流无效或体重复发而接受 SG 至 RYGB 转换手术的患者进行了队列研究，这些患者的转换手术指征为 2009 年至 2023 年期间出现上述情况。体重动态分析采用两种体重参考值：SG 前（意向治疗）和转换前。
在转换手术时，体重、身体质量指数（BMI）、多余体重减轻百分比（%EWL）和总体重减轻百分比（%TWL）的平均值分别为 92.2 ± 25.2kg、34.3 ± 8.0kg/m、55.2% ± 39.9%和 22.8% ± 15.2%，分别为意向治疗时 SG 前的体重、SG 前的体重计算。转换后最低体重、BMI、%EWL 和 %TWL（SG 前的体重计算）的平均值分别为 71.1 ± 18.4kg、26.7 ± 5.5kg/m、96.5% ± 30.5%和 40.2% ± 10.6%。在随访时，体重、BMI、%EWL 和 %TWL（SG 前的体重计算）的平均值分别为 80.4 ± 17.7kg、29.6 ± 5.4kg/m、78.9% ± 26.8%和 33.3% ± 11.2%。转换后最低体重时 %EWLio 和 %TWLio（转换前的体重=指数手术的 EWL）的平均值分别为 73.2% ± 92.7%和 20.1% ± 12.2%，分别下降至最后随访时的 41.9% ± 94.0%和 13.2% ± 15.2%（平均 6.6 年）。
SG 至 RYGB 转换在短期内提供中度至低度的补充减重。3-4 年后，体重有明显增加的趋势。
