Outcomes of re-operative surgery in severely obese patients after sleeve gastrectomy: A single institution experience

Abstract Background Despite its popularity, sleeve gastrectomy (SG) is not devoid of postoperative complications and weight regain. Some of these cases warrant conversion to Roux-en-Y gastric bypass (RYGB) or proximal gastrectomy with Roux-en-Y esophagojejunostomy (PGRYEJ). Complications after conversion are scarcely reported in the literature. Objectives Report and review the outcomes of reoperation on severely obese patients with weight regain or complications after SG. Setting Bariatric Surgery Center of Excellence; Community Hospital, United States. Methods We retrospectively reviewed the medical records of patients converted from SG to RYGB/PGRYEJ at our center, from 2004 to 2018. Patients were stratified by reason for conversion. Group A included those converted for complications (leaks, strictures or gastroesophageal disease [GERD]) and group B for reported weight regain. Demographics, postoperative outcomes, and complications were described. Results From 77 conversions identified, 63.6% (n=49) underwent primary SG at an outside hospital (OSH). We observed predominant female (68.8%;n=53) and Caucasian (76.6%;n=59) populations. Conversions for complications were performed in 67.5% (n=52) and for weight regain in 32.4%(n=25). The most common conversion indication in group A was chronic leak (29.9%;n=23), followed by GERD (20.8%;n=16), and stricture (16.9%;n=13). Overall, major complications occurred in 16.9% (n=13) and minor complications in 19.4% (n=15). In group A, most common major complications were anastomotic leak and organ space surgical site infection (SSI) (3.9%;n=2;each); the most common minor complication was nonperforated marginal ulcer (7.7%;n=4). In group-B, the most common major complication was perforated marginal ulcer (8%;n=2); the most common minor complication was stricture (16%;n=4). Group B mean pre-conversion body mass index (BMI) was 38.4±4.3 and percentage excess BMI loss (EBMIL%) was 48±33, 63±45, 59±63 and 73±25 (12, 24, 36, ≥48 months). Conclusions Our experience shows that major complications can occur in up to 17% of patients after conversion. Conversion to RYGB in non-responders appears to be a safe and effective option for BMI reduction.