Marwaha Jayson S, Belayneh Miskir, Bloomfield Grace C, Clarke Narica, Vadlamudi Chaitanya, Pardo Lameda Ivanesa L, Alimi Yewande R
Department of Surgery, Georgetown University Medical Center, Washington, DC, USA.
Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
Surg Endosc. 2025 Jan;39(1):459-464. doi: 10.1007/s00464-024-11280-1. Epub 2024 Oct 6.
Sleeve gastrectomy to Roux-en-Y bypass conversion is a commonly performed procedure, yet data are limited on outcomes and their predictors. The purpose of this study is to characterize the long-term outcomes of patients after sleeve-to-bypass conversion and identify predictors of post-conversion outcomes.
We performed a retrospective cohort study of patients who underwent sleeve-to-bypass conversion for obesity across four hospitals from 06/2017 to 04/2023. Predictors of the below-average percent excess weight loss (%EWL; relative to pre-conversion weight) at 1 and 2 years following conversion were identified using multivariate logistic regression models adjusting for comorbidities, demographics, and neighborhood socioeconomic status.
150 Patients undergoing sleeve-to-bypass conversion were identified. 99 had 1-year data and 63 had 2-year data. Mean %EWL at 1- and 2-years following conversion were 40.2% and 37.4%, respectively. EWL > 40% after sleeve gastrectomy was an independent predictor of the below-average %EWL 1-year post-conversion (OR 10.0, 95% CI 2.2-63.0, p < 0.01), and BMI > 40 kg/m at the time of conversion was an independent predictor of both 1- and 2-year below-average %EWL post-conversion (p = 0.01 and 0.05, respectively). Insignificant predictors of the below-average %EWL after conversion included: weight regain after sleeve, time between sleeve and conversion, alimentary limb length, and any bariatric surgery prior to sleeve gastrectomy.
Patients should be counseled that the typical expected %EWL for sleeve-to-bypass conversion is less than the 50% EWL benchmark of success for index bariatric operations. The main predictors of a suboptimal conversion outcome are > 40% EWL after sleeve or > 40 BMI kg/m at the time of conversion. Most variables in our analysis were not predictors of post-conversion %EWL, including weight regain between sleeve and conversion, alimentary limb length, and time interval between procedures, which suggests that these factors should not play a large role when considering sleeve-to-bypass conversion.
袖状胃切除术转为 Roux-en-Y 旁路手术是一种常见的手术，但关于其结果及其预测因素的数据有限。本研究的目的是描述袖状胃切除术转为旁路手术后患者的长期结果，并确定术后结果的预测因素。
我们对 2017 年 6 月至 2023 年 4 月期间在四家医院接受袖状胃切除术转为旁路手术治疗肥胖症的患者进行了一项回顾性队列研究。使用多因素逻辑回归模型确定转换后 1 年和 2 年时体重减轻百分比低于平均水平（相对于转换前体重的%EWL）的预测因素，该模型对合并症、人口统计学和社区社会经济状况进行了调整。
共确定了 150 例接受袖状胃切除术转为旁路手术的患者。99 例有 1 年的数据，63 例有 2 年的数据。转换后 1 年和 2 年时的平均%EWL 分别为 40.2%和 37.4%。袖状胃切除术后 EWL>40%是转换后 1 年时%EWL 低于平均水平的独立预测因素（OR 10.0，95%CI 2.2-63.0，p<0.01），转换时 BMI>40 kg/m²是转换后 1 年和 2 年时%EWL 低于平均水平的独立预测因素（分别为 p=0.01 和 0.05）。转换后%EWL 低于平均水平的无显著预测因素包括：袖状胃切除术后体重反弹、袖状胃切除术与转换之间的时间、消化道长度以及袖状胃切除术之前的任何减肥手术。
应告知患者，袖状胃切除术转为旁路手术的典型预期%EWL 低于减肥手术成功的 50%EWL 基准。转换结果不理想的主要预测因素是袖状胃切除术后 EWL>40%或转换时 BMI>40 kg/m²。我们分析中的大多数变量不是转换后%EWL 的预测因素，包括袖状胃切除术与转换之间的体重反弹、消化道长度以及手术之间的时间间隔，这表明在考虑袖状胃切除术转为旁路手术时，这些因素不应起很大作用。
