Laparoscopic conversion of Roux-en-Y gastric bypass to biliopancreatic diversion.

BACKGROUND: This report describes the laparoscopic conversion of a Roux-en-Y gastric bypass (RYGBP) to biliopancreatic diversion (BPD). CASE REPORT: In January 1995, a 47-year-old woman with a body mass index (BMI) of 54 kg/m(2) benefited from a silicon ring vertical banded gastroplasty (SRVBG) for morbid obesity. She showed significant weight loss and reached a BMI of 30 kg/m(2). After 7 years, she experienced weight regain (BMI, 34.5 kg/m(2)), so a laparoscopic conversion to RYGBP was proposed. The patient again had a successful weight loss (BMI, 26 kg/m(2)), but 6 years later, she mentioned a weight regain (BMI, 33 kg/m(2)) with invalidating retrosternal pain. The nutritionist's analysis of the patient showed a certain modification of the alimentary character with frequent meals (grazing/polyphagia), and the psychologist's consultation identified an important binge-eating disorder. A laparoscopic conversion of RYGBP to BPD was proposed. The procedure consisted of (1) adhesiolysis and reduction of a hiatal hernia, (2) sectioning of the gastric pouch proximally to the gastrojejunostomy, (3) resection of the fundus of the gastric remnant excluded by the previous SRVBG, (4) restoration of the continuity of the stomach between the gastric pouch and the gastric remnant, (5) resection of the gastric antrum and pylorus, (6) deconstruction of the previous jejunojejunostomy, (7) restoration of the continuity of the small bowel, (8) measurement of the new common and alimentary limbs and construction of the jejunoileostomy, (9) closure of the mesenteric defect, (10) construction of the gastroileostomy, (11) closure of Petersen's space, and (12) repair of the hiatal hernia followed by a leak test. RESULTS: The operative time was 320 min, and the blood loss was 380 ml. The patient had an uneventful recovery and was discharged on postoperative day 5. Her BMI was 30.5 kg/m(2) after 3 months and 26 kg/m(2) after 6 months. The barium swallow showed good transit through the gastrointestinal tract. CONCLUSIONS: The laparoscopic conversion of RYGBP to BPD is technically feasible and effective during the short term for cases of repeated weight regain.