Conversion of Vertical Sleeve Gastrectomy to a Functional Single-Anastomosis Gastric Bypass: Technique and Preliminary Results Using a Non-Adjustable Ring Instead of Stapled Division

BACKGROUND Recent data show that some patients will have insufficient weight loss or experience weight regain after sleeve gastrectomy. Dilation of the sleeve over time or use of an inadequate technique may contribute to relapse of morbid obesity. Repeat sleeve gastrectomy is the most obvious option but requires stapling of scarred tissue, has a higher risk of leakage, and is prone to re-enlargement with time. We herein describe a simple and innovative technique with which to revise vertical sleeve gastrectomy (VSG) into functional single-anastomosis gastric bypass (f-SAGB). MATERIALS AND METHODS Twelve VSGs were converted to f-SAGB by placing a GaBP Ring (Bariatec Corp., Palos Verdes Peninsula, CA, USA) at the base of the "sleeve" and performing the anastomosis above the ring. The length of the biliopancreatic loop was chosen according to the volume of the pouch and the patient's residual eating capability. RESULTS All procedures were completed by laparoscopy and were uneventful. The average decrease in the body mass index was from 41.0 to 29.5 kg/m2 at the 12-month follow-up. No ring-related complications were reported. CONCLUSION f-SAGB is a low-risk and effective option with which to revise VSG in patients with inadequate weight loss. Avoiding detachment of the pouch from the antrum assures full reversibility of the procedure and preserves the chance to explore the remnant stomach and biliary tree.