Conversion of Sleeve Gastrectomy to Roux en-Y Gastric Bypass for Complications: Outcomes from a Tertiary Referral Center in The Middle East

ABSTRACT Background Complications following Sleeve Gastrectomy (SG) unfortunately leads a subset of patients to require revisional surgery, including conversion to Roux-en-Y gastric bypass (RYGB). Objectives We aimed to describe the indications for conversion and perioperative outcomes in this subset of patients. Setting Academic Hospital, Abu Dhabi, United Arab Emirates. Methods All patients undergoing conversion from SG to RYGB from September 2015 to December 2018 were retrospectively reviewed. Patients who underwent conversion solely for weight recidivism were excluded from analysis. Results Forty-seven patients underwent conversion to RYGB due to complications from SG. The cohort was 76.5% female with a mean age of 39 years and median Body Mass Index (BMI) of 34 kg/m2. The median time between SG and RYGB was 36 months. Indications warranting conversion included mechanical complications (n=24, 51.1%), intractable reflux (n=21, 44.7%) and fistula (n=2, 4.2%). Preoperative mechanical abnormalities included hiatal hernia (n=13, 27.7%), helical twist (n=10, 21.3%), sleeve stenosis/stricture (n= 5, 10.6%), fistula (n=2, 4.2%), and leak (n=1, 2.1%). Each conversion was completed with a laparoscopic approach, with a median length of stay of 3 days. Four patients (8.5%) experienced complications within 30 days, including two patients (4.2%) with superficial surgical site infection, one patient each (2.1%) with gastrointestinal hemorrhage and anastomotic leak. There were no mortalities at median follow-up of 17 months. Conclusion In this series, representing the largest reported single-center experience in the Middle East, conversion of SG to RYGB was safe and effective for the treatment of symptoms and mechanical complications following SG.