• Robert A Casillas, Scott S Um, Jorge L Zelada Getty, Samantha Sachs, and Benjamin B Kim.
• Department of Bariatric Surgery, Kaiser Permanente, West Los Angeles, CA. Electronic address: bcsurgeon2001@yahoo.com.
• Surg Obes Relat Dis. 2016 Dec 1; 12 (10): 1817-1825.

BackgroundLaparoscopic sleeve gastrectomy (SG) has become an accepted primary bariatric operation. Like other bariatric operations, inadequate weight loss and complications have been reported.ObjectivesThe aim of this study was to assess the indications and outcomes of revision of SG to laparoscopic Roux-en-Y gastric bypass (RYGB) at a single community hospital.SettingCommunity hospital, United States.MethodsRetrospective review of a prospectively collected database identifying SG operations done from February 2009 to June 2014. All patients who underwent revision from SG to RYGB were studied.ResultsForty-eight patients underwent revision of SG to RYGB. Mean time to revision was 26 months (range, 2-60 mo) and mean follow up after RYGB was 20 months (range, 4-48 mo). Indications for revision were reflux (n = 14), inadequate weight loss (n = 11), reflux and inadequate weight loss (n = 16), stricture (n = 4), chronic leak (n = 1), and recurrent diabetes and reflux (n = 2). Reflux symptoms resolved in 96% of patients after revision, and hiatal hernias were repaired in 50% of patients. Percentage total weight loss at 3, 6, 12, 24, and 36 months was 9.0%, 12.9%, 15.7%, 13.3%, and 6.5%, respectively. The overall rate of complication was 31%. There were no mortalities.ConclusionsRevision of SG to RYGB is a potentially effective means of treating SG complications, particularly reflux. Reflux was the most common indication for revision and was often associated with a hiatal hernia. Further studies will be necessary to evaluate the long-term maintenance of additional weight loss after revision of SG to RYGB.Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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