Exploring the Efficacy of Single-stage Stapled Conversion of Gastric Bypass to Sleeve Gastrectomy, More Leak?

Overview

Laparoscopic gastric bypass - including both Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) - is one of the most frequently performed procedures. However, as the number of gastric bypass surgeries increases, complications are being reported more often. While most post-bypass complications can be managed non-surgically, a small number of persistent cases may require a reversal to normal anatomy or conversion to another procedure. Many patients who experience severe complications from gastric bypass are reluctant to undergo a reversal to normal anatomy due to fears of regaining weight. As a result, converting to another type of surgery becomes a more logical alternative. Complications requiring conversion are numerous and negatively affect the quality of life, such as retrograde intussusception, weight regain, intractable dumping syndrome, and nutritional deficiencies. The high cost of obligatory postoperative vitamins is a potential cause of conversion especially in low-income countries. The conversion procedure is technically demanding and has a relatively higher rate of postoperative complications, making it less commonly performed. Additionally, limited data is available regarding the procedure and its long-term outcomes, making it an unexplored sea of hope for people who wish to manage intractable complications of gastric bypass and maintain weight loss.

Detailed description

Objectives: To study efficacy, safety, and patient outcomes following laparoscopic gastric bypass conversion to sleeve gastrectomy.

Study population \& Sample size :

Adult patients undergoing single-stage laparoscopic stapled conversion of gastric bypass to sleeve gastrectomy in Kasr Alainy Sample size: 11 patients Study Design: This is a prospective single-arm clinical trial.

Methods: Patients who will attend our bariatric outpatient clinic will be enlisted according to inclusion criteria. A detailed history of anthropometric measures, chronic diseases, and previous surgeries will be recorded. After patient education, preoperative routine labs and imaging will be performed.

A preoperative 3D gastric volumetry CT scan will be performed to all patients included in this study.

The procedure will consist of converting the gastric bypass to a sleeve gastrectomy using a stapling technique.

The average length of hospital stay will be included. Follow up of nutritional status will be done using laboratory parameters (Hb, Ferritin, Vitamin D, Zn, Mg, serum Albumin, Calcium) in 3 months and 6 months postoperatively, quality of life will be assessed using bariatric quality of life index in 3 months and 6 months postoperatively.

Patient weight will be documented monthly to evaluate weight regain, GERD symptoms will be assessed using GERD score in 3 months and 6 months postoperatively.

Possible Risk (s) to study population:

1. Postoperative pain. 2. Postoperative nausea and vomiting. 3. Bleeding 4. Anastomotic leakage 5. Stricture

Outcome parameters:

* Primary outcomes

1. Improvement of nutritional status. 2. Weight regain. * Secondary outcome parameters

1. Quality of life 2. GERD symptoms

Statistical analysis plan:

Data analysis packages will be SPSS version 21. Qualitative data will be presented by number and percentage, quantitative data will be presented by mean, standard deviation, median, and interquartile range.

Parametric and non-parametric tests of significant will be done (chi-square, student t-test, and Mann-Whitney test).

Correlation analysis tests and regression will be done. The level of significance was set at p equal to or below 0.05.

Interventions

• Procedure Stapled reversal of gastric bypass to sleeve gastrectomy utilising stapling technique.
  This research entails a single-stage laparoscopic conversion of gastric bypass to sleeve gastrectomy. The procedure entails the closure of the gastrojejunostomy with an endo-stapler and the reconstruction of the stomach by resecting along the greater curvature to create a sleeve gastrectomy. An intraoperative leak test will be conducted using methylene blue. Patients are monitored postoperatively for at least 24 hours, with subsequent assessments of nutritional status, weight, gastroesophageal r

Primary outcome measures

• Nutritional Status [Time frame: one year]
• Weight Regain [Time frame: one year]

Secondary outcome measures (2)

• Quality of Life [Time frame: one year]
• GERG symptoms [Time frame: One year]

Eligibility criteria

Inclusion criteria

• Age between 18-70
• Adult patients undergoing single-stage laparoscopic stapled conversion of gastric bypass to sleeve gastrectomy.
• Patients accept to sign an informed consent and will commit to follow-up.

Exclusion criteria

• Patients with reversal gastric bypass to normal anatomy.
• Patient with uncontrolled systemic disease.
• Patients with active psychological disorders.
• Patients with active substance abuse.
• Patients with intra-operative technical difficulties hindering the conversion of gastric bypass to sleeve gastrectomy.
• Patients refusing to sign an informed consent.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

Egypt · 1 center

• Kasr Alainy Medical School, Cairo University — Cairo

Publications

• Okut G, Turgut E, Kaplan K, Sumer F, Kayaalp C. Can revision of RYGB to sleeve gastrectomy be a solution to inadequate weight loss treatment? Cir Cir. 2022;90(S1):25-30. doi: 10.24875/CIRU.21000458. PMID 35944120
• Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004 Dec 23;351(26):2683-93. doi: 10.1056/NEJMoa035622. PMID 15616203

Identifiers

NCT: NCT07038148 · N-8-2025

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗