From the Guidelines
Conversion to Roux-en-Y (RNY) gastric bypass is necessary in patients who experience complications or inadequate results from prior bariatric procedures, such as severe gastroesophageal reflux disease (GERD), inadequate weight loss, or significant weight regain, as well as those with chronic gastric fistulas, severe gastric stenosis, or band-related complications 1.
Clinical Scenarios for Conversion
The decision to convert to RNY bypass is based on several clinical scenarios, including:
- Severe gastroesophageal reflux disease (GERD) that remains uncontrolled despite medical therapy, especially after sleeve gastrectomy which can worsen reflux in some patients
- Inadequate weight loss or significant weight regain following primary bariatric procedures, as RNY provides both restrictive and malabsorptive mechanisms
- Chronic gastric fistulas, severe gastric stenosis unresponsive to endoscopic interventions, and band-related complications such as erosion, slippage, or pouch dilation in patients with adjustable gastric bands
Evaluation and Considerations
The decision for conversion should be made after thorough evaluation including:
- Upper endoscopy
- Contrast studies
- Nutritional assessment Patients should understand that conversion procedures typically carry higher complication rates than primary surgeries, with potential risks including anastomotic leaks, strictures, internal hernias, and nutritional deficiencies requiring lifelong vitamin supplementation and monitoring 1.
Timing of Conversion
The timing of conversion varies by indication but generally occurs after conservative management options have been exhausted. In some cases, such as severe morbid obesity or developing progressive non-alcoholic steatohepatitis (NASH) with fibrosis in allograft, bariatric surgery, including RNY bypass, may be considered as a treatment option 1.
From the Research
Conversion to Roux-en-Y Bypass
The conversion to Roux-en-Y (RNY) bypass is necessary in several situations, including:
- Failed gastric restrictive operations, where patients have not achieved significant weight loss or have experienced complications such as gastroesophageal reflux disease (GERD) or band problems 2
- Morbidly obese patients who have not responded to other treatments and require a more effective method for weight loss and improvement of comorbid conditions 3, 4
- Patients with Barrett's esophagus, where RYGB can help eliminate duodenogastric reflux and potentially reduce the length and presence of dysplasia 5
- Patients who have undergone adjustable gastric banding or sleeve gastrectomy but have not achieved adequate weight loss or have experienced complications 6
Indications for Conversion
The indications for conversion to RNY bypass include:
- Inadequate weight loss or weight regain after a previous bariatric procedure 2
- Presence of comorbid conditions such as GERD, diabetes, or hypertension that have not been adequately managed with other treatments 3, 4
- Complications from a previous bariatric procedure, such as band problems or staple-line disruptions 2, 4
- Patient preference for a more effective and durable weight loss procedure 6
Benefits of Conversion
The benefits of conversion to RNY bypass include:
- Significant and sustainable weight loss 2, 4, 6
- Improvement or resolution of comorbid conditions such as GERD, diabetes, and hypertension 3, 4
- Reduction in the length and presence of dysplasia in patients with Barrett's esophagus 5
- Improved quality of life and reduced risk of obesity-related complications 2, 6