Outcomes of conversions in bariatric surgery mendoza 2011

Outcomes of Conversions in Bariatric Surgery Samer G. Mattar, MD, FRCS, FACS Associate Professor of Surgery Indiana University

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object]

Growth of Bariatric Surgery: 500% NEJM 350;11, 2004, March 11, 1075-1079

Bariatric Surgery Increase Total number of Roux-en-Y Gastric Bypasses Performed in the USA* *National Center for Health Statistics 1998 25000 1999 23000 2000 38000 2002 40000 2004 140000 2005 170000 2008 220,000

Incidence of Revisional Bariatric Surgery ,[object Object],[object Object],[object Object]

Incidence of Revisional Bariatric Surgery

Definitions ,[object Object],[object Object],[object Object],[object Object]

Definition of Failed Bariatric Surgery ,[object Object],[object Object],[object Object]

Causes of Failed Bariatric Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object]

Late Complications of Bariatric Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation of the failed patient ,[object Object]

Evaluation of the failed patient ,[object Object],[object Object],[object Object]

Evaluation of the failed patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Evaluation of the failed patient ,[object Object],[object Object],[object Object],[object Object]

Who should not be converted? ,[object Object],[object Object],[object Object],[object Object]

Revisional Surgery Options ,[object Object],[object Object],[object Object],[object Object],[object Object]

VBG RYGB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

VBG RYGB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gagne et al SOARD Online first

Sleeve gastrectomy RYGB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Langer FB, et al; Obes Surg; Online April 15, 2010

Failed LAGB Reband or Convert? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Muller MK, et al; Surg Endosc (2008);22:448-53

Failed LAGB Reband or Convert? Dotted line = Re-banded patients Solid line = Patients converted to LRYGB p = 0.035 Muller MK, et al; Surg Endosc (2008);22:448-53

Gastric Band RYGB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Moore R et al, SOARD 2009;5(4):439-43

Gastric Band RYGB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Langer FB, et al; Obes Surg 2008; 18(11):1381-6

Gastric Band Sleeve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Foletto M et al; SOARD 2010;6(2):146-52

Gastric Band Sleeve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Foletto M et al; SOARD 2010;6(2):146-52

RYGB RYGB + Band ,[object Object],[object Object],[object Object],[object Object],[object Object],Bessler M et al; SOARD; 6(1):31-5

RYGB RYGB + Band Bessler M et al; SOARD; 6(1):31-5

RYGB Malabsorption ,[object Object],[object Object],[object Object]

RYGB Malabsorption ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Revision to Duodenal Switch ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Keshishian A et al; Obes Surg 2004;14(9):1187-92

Re-operative Bariatric Surgery ,[object Object],[object Object],[object Object],Patel, Szomstein, Rosenthal. Obes Surg Online first July 2010

Indications Patel, Szomstein, Rosenthal. Obes Surg Online first July 2010 Gastrogastric fistula 41% Ulcer, reflux, bleeding 30.5% Strictures and outlet obstructions 23 % Eroded anastomotic rings 8% Weight loss with malnutrition 7%

Re-Operative Procedures ,[object Object],[object Object],[object Object],[object Object],Patel, Szomstein, Rosenthal. Obes Surg Online first July 2010

Outcomes * all patients required immediate operative intervention Patel, Szomstein, Rosenthal. Obes Surg Online first July 2010 Postoperative Complications n % Leaks 20 13.2 Wound infection 5 3.3 Intra-abdominal abscess 4 2.6 Trocar site hernia* 3 2.0 Gastrointestinal bleeding* 1 0.7

Outcomes ,[object Object],[object Object],[object Object],[object Object],Patel, Szomstein, Rosenthal. Obes Surg Online first July 2010

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object]

Outcomes of conversions in bariatric surgery mendoza 2011

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Outcomes of conversions in bariatric surgery mendoza 2011