Poster Presentation ANZOS-OSSANZ-AOCO Joint Annual Scientific Meeting 2017

Laparoscopic conversion of Single Loop Bypass to a Roux Loop - Video Presentation (#253)

Lash Wickramasuriya 1 , George Hopkins 1 2
  1. Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
  2. Holy Spirit Northside Private Hospital, Brisbane, QLD, Australia

Purpose:

Single loop gastric bypass (SLGB) is an alternative procedure to the Roux-en-y gastric bypass (RYGB); the latter being the gold standard approach for surgical management of morbid obesity in Australia. Concerns exist regarding possible long-term complications from SLGB specifically related to bile acid reflux and associated oesophagitis and marginal ulcer formation.(1-5) Our group has now performed SLGB as both a primary procedure and as a revisional procedure for gastric banding for three years. A number of these have had to be converted to a roux loop. We would like to present the outcomes of twelve cases explaining the indication for conversion to Roux and in some cases refashioning of the gastrojejunostomy; providing an intraoperative video example of this.

Methods:

From September 2015 to April 2017, twelve patients underwent laparoscopic revision of their SLGB to a roux limb performed via a 5-port technique. Three of the cases required resection and then refashioning of the gastro-jejunostomy along with formation of a new jejuno-jejunostomy. In the remaining nine, the biliary limb was detached from the gastro-jejunostomy and re-inserted as a new roux limb 50cm distally.

Results:

Indication for roux-limb was bile-reflux in 58% of the cases. Median time from SLGB to revisional RYGB was 6.5 months. All patients recovered well with good resolution of their prior symptoms. One case had a complication from surgery necessitating re-operation for reduction of internal hernia. Two others required subsequent laparoscopic division of adhesions for pain.

Conclusion:

It is imperative that with the growing popularity of the SLGB procedure, bariatric surgeons can successfully perform revisonal roux-loop surgery if complications arise. We present 12 cases with good results of symptom resolution and a video outlining one successful case that required refashioning of the gastro-jejunostomy. We will discuss the evolution of this technique and limitations of this emerging issue.

  1. 1. Nimeri A, Al Shaban T, Maasher A. Laparoscopic conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2017;13(1):119-21.
  2. 2. Mahawar KK, Reed AN, Graham YNH. Marginal ulcers after one anastomosis (mini) gastric bypass: a survey of surgeons. Clinical obesity. 2017;7(3):151-6.
  3. 3. Kassir R, Alamri T, Lointier P. Laparoscopic Conversion of Omega Loop Gastric Bypass into Roux-en-Y Gastric Bypass. Obesity surgery. 2017;27(5):1392-3.
  4. 4. Godina M, Nagliati C, Menegon P, Caruso V. Emergency laparoscopic conversion from mini/one anastomosis gastric bypass to modified Roux-en-Y-gastric bypass due to acute bleeding from a recurrent marginal ulcer. Updates in surgery. 2017.
  5. 5. Amor IB, Petrucciani N, Kassir R, Al Munifi A, Piche T, Debs T, et al. Laparoscopic Conversion of One Anastomosis Gastric Bypass to a Standard Roux-en-Y Gastric Bypass. Obesity surgery. 2017;27(5):1398.