by Jerome Lyn-Sue, MD; Kimberley Steele, MD; Michael A. Schweitzer, MD; Thomas Magnuson, MD; Anne Lidor, MD; Anirban Gupta, MD; and Patrick Okolo, MD.

All from Johns Hopkins University School of Medicine, Baltimore, Maryland.

Introduction
Roux-en-Y gastric bypass is the most effective and most commonly performed bariatric surgical procedure in the United States.1 While improvements in surgical technique have significantly reduced postoperative complication rates, anastomotic leak continues to occur and remains an important cause of postoperative morbidity and mortality.2 Repair of an anastomotic leak may involve open or laparoscopic surgical re-exploration, which can contribute to the morbidity of this life-threatening complication.3 A transoral endoscopic approach, using a covered stent, has the potential to avoid further morbidity from a potentially difficult intra-abdominal attempt at repairing the hole. Covered stents have been used for esophageal anastomotic leaks following non-bariatric procedures with good success. Several reports have described the effective use of this therapy for such leaks, as well as for malignant esophageal fistulas.4,5 Read the rest of this article »

Manish Parikh, MD; and Michel Gagner, MD, FRCSC, FACS

Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida

Objective. To report preliminary outcomes after laparoscopic conversion of gastric bypass to biliopancreatic diversion with duodenal switch for weight loss failure.
Design. Retrospective chart review.
Setting. Academic tertiary referral center.
Participants. Twelve patients with weight loss failure after gastric bypass.
Measurements. Age, body mass index, excess weight loss, type of primary gastric bypass, type of revision procedure performed (if applicable), method of gastrogastrostomy, intraoperative and perioperative data, and morbidity and mortality rates.
Results. All patients lost dramatic weight after conversion to duodenal switch: Mean excess weight loss (EWL) was 63 percent at 11 months, representing an average
11-point BMI decrease. There were no mortalities or leaks. Stricture at the gastrogastrostomy was the most frequent complication, which was usually amenable to endoscopic dilation.
Conclusions. Laparoscopic conversion to duodenal switch from failed gastric bypass is highly effective with an acceptable morbidity

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by Kenneth B. Jones, Jr., MD, FACS

Clinical Assistant Professor of Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.

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