Background

Serious weight regain or inadequate weight loss following a gastric bypass operation is a challenging problem. In an attempt rectify this, 15 patients were converted from a Roux en-Y gastric bypass to a Biliopancreatic Diversion with duodenal switch and evaluated in a retrospective review. The average age was 52.6 years with 86.6% female. 12 were single anastomosis (SADI) with 3 classic dual anastomoses. 11 cases were completed robotically and 4 had planned open operations. The average operative time was 329.8 minutes (range 239-410 mins). 10 of the 15 were found to have an inadequate gastric pouch from the initial gastric bypass on endoscopy and the gastric reconstruction was accomplished with a jejunal interposition. The average weight loss at 1 year was 62 lbs with BMI decreased by an average of 10.6. The average percent excess weight loss was 36.7% with a average total body weight loss of 19.7%. There were no mortalities. 5 patients had complications with 3 leaks (20%) of which one required a return to the OR, 1 Pulmonary embolism and 1 surgical site infection. The mean LOS was 3 days for those without a leak and 30 days if a leak occurred for an overall average LOS of 8.9 days.

Conclusions

Conversion of a RYGB to a BPD-DS is an effective but high risk solution for this difficult problem.