Conversion of failed Roux-en-Y gastric bypass to biliopancreatic diversion with duodenal switch: outcomes of 9 case series.

Introduction: Weight regain after Roux-en-Y gastric bypass (RYGB) is a frustrating long-term complication in some patients. Revision of RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) is an appealing option. There is a paucity of information in literature regarding this type of conversion.

Setting: Regional referral center and teaching hospital, Pennsylvania, United States; nonprofit.

Methods: Between 2013 and 2016, a retrospective chart review was performed on all our revision cases. Patients who underwent conversion from RYGB to BPD-DS were selected and analyzed.

Results: Conversion from RYGB to BPD-DS was performed on 9 patients (8 females, 1 male; mean age: 49.2±7.6 [36-61] years). The mean body mass index (BMI) before the initial RYGB was 54.2±14.2 (36.2-79) kg/m. The lowest mean BMI reached before conversion was 33.9±6.2 (27.9-43.3) kg/m before it increased to 45.6±8.7 (28.8-60.2) corresponding to excess weight loss (EWL) of 33.1%±17.7% (10.6%-68.1%), before conversion. The average operative time was 402.6±65.8 (328-515) minutes for 1-stage conversions. No morbidities, reoperation, or readmission over 30 days postoperatively were reported. No leaks or mortalities were identified. The mean duration of follow-up postconversion is 16.3±13.6 (3-42) months. After conversion surgery, the mean BMI was 35.8±8.2 (27.6-49.5) kg/m, while mean EWL loss was 64.1%±18.8% (45.9%-88.7%). The BMI of the cohort decreased by a mean of 9.8±5.1 (0.5-16.8) and the EWL increased by 31%±23.1% (4%-76.6%).

Conclusion: Our results indicate that conversion of failed RYGB to BPD-DS is laparoscopically or robotically safe and effective. A large cohort study with long-term follow-up is necessary to further assess the safety and efficacy of this method.