Page 63 - Read Online

Spurzem et al. Mini-invasive Surg. 2025;9:10 https://dx.doi.org/10.20517/2574-1225.2024.96 Page 3 of 8

Surgical technique
For conversion from sleeve gastrectomy (SG) to one-anastomosis gastric bypass (OAGB), we begin by using
a 34 Fr bougie dilator as a guide to create an approximately 15-20 cm gastric pouch with a 60 mm linear
stapler. Indocyanine green (ICG) is used to assess vascular perfusion during this step. Hook cautery is then
used to create an opening in the gastric pouch posterior to the staple line. We then identify the ligament of
Treitz and count 200 cm distally. The small bowel is then brought up to the gastric pouch at this point and a
stapled gastrojejunal anastomosis is created with a linear stapler. The bougie is then advanced into the small
bowel and the common enterotomy is closed in 2 layers (inner absorbable, outer permanent). A complete
upper endoscopy is then performed.

Re-SG was performed for SG revision. A 34 Fr bougie dilator is first advanced into the pylorus and placed
under suction. Using this as a guide, vertical SG is then performed using a 60 mm linear stapler with staple
line reinforcement beginning about 6 cm from the pylorus. The stomach is stapled from the pylorus parallel
to the lesser curve toward the angle of His. The upper 10 cm of the staple line is then imbricated with
absorbable suture and reinforced with surgical glue. A complete upper endoscopy is then performed. Two-
stage gastric band to SG conversion is performed in a similar fashion after removing the band.

Roux-en-Y gastric bypass (RYGB) revisions were performed endoscopically and surgically. Endoscopic
revisions involved plication of the gastric pouch and gastrojejunal anastomosis or gastrogastric fistula
closure. Surgical revisions involved a stapled gastric pouch revision with or without candy cane limb
resection.

Statistical analysis
For categorical variables, Fisher’s exact test was used to compare small samples, otherwise Pearson’s chi-
square test was used. Independent sample t-test was used to compare continuous variables. A P-value of
< 0.05 was considered statistically significant. All statistical analyses were performed in R (Version 4.4.1,
Vienna, Austria).

RESULTS
Patient demographics and operative data
Seventy patients were identified. Patient demographics and operative data are detailed in Table 1. The
average patient age was 46.3 ± 9.9 years, most were female (97.1%), and the average BMI at the time of
2
revisional surgery was 40.2 ± 6.3 kg/m . Among all patients, the most common initial weight loss procedure
performed prior to undergoing revisional surgery was laparoscopic RYGB (40.0%, N = 28), followed by
laparoscopic SG (32.9%, N = 23), open RYGB (15.7%, N = 11), and laparoscopic gastric band (11.4%, N = 8).
The mean operative time across all revisional cases was 79.5 ± 37.2 minutes, the mean LOS was 1.1 ± 0.8
days, and the mean follow-up time was 8.7 ± 4.7 months.

Five types of revisional procedures were performed: 39 (55.7%) RYGB revisions (21 endoscopic, 11
laparoscopic, 6 robotic, 1 open), 15 (21.4%) SG to OAGB conversions (8 robotic, 7 laparoscopic), 8 (11.4%)
SG revisions (7 laparoscopic, 1 robotic), 7 (10.0%) laparoscopic gastric band to SG conversions, and 1 (1.4%)
laparoscopic gastric band to OAGB conversion. The most common RYGB revision was for gastric pouch
and/or gastrojejunostomy (GJ) revision (79.5%, N = 31), followed by closure of a gastrogastric fistula (15.4%,
N = 6), and candy cane limb resection (5.1%, N = 2). All SG revisions were performed for retained gastric
fundus.