胃袖状切除术与Roux—en—Y胃旁路术治疗2型糖尿病疗效的Meta分析

目的系统评价胃袖状切除术与Roux—en—Y胃旁路术治疗2型糖尿病的疗效。方法以减重手术、胃切除术、胃绕道术、胃旁路手术、胃转流术、胃袖状切除术、糖尿病、bariatricsurgery、gastricbypass、sleevegastrectomy、diabetes、T2DM等为关键词检索Cochranelibrary、PubMed、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊全文数据库和万方数据库。检索时间为各数据库建库至2012年12月。最终纳入胃袖状切除术对比Roux—en—Y胃旁路术治疗2型糖尿病的相关文献,再由2名研究者分别独立提取数据并进行文献质量评价,用RevMan5．1．2软件进行Meta分析。计数资料采用相对危险度（riskratio,RR）或比值比（oddsratio,OR）分析统计,计量资料采用均数差（meandifference,MD）或标准差（standardmeandifference,SMD）分析统计。采用Jr2对异质性进行定量分析。结果共纳入符合标准的文献5篇,其中胃袖状切除术组164例,Roux—en—Y胃旁路术组184例。Meta分析结果显示：与胃袖状切除术比较,Roux—en—Y胃旁路术能更显著地提高患者糖尿病的缓解率（OR=0．48,95％C／：0．26～0．91,P〈0．05）,提高随访期间停止服药的比例（OR=0．37,95％C／：0．16～0．84,P〈0．05）,更有效降低糖化血红蛋白水平（MD=0．28,95％C／：0．14—0．43,P〈0．05）和体质量（MD=-0．44,95％CI：-0．76～-0．13,P〈0．05）。胃袖状切除术与Roux—ell—Y胃旁路术患者术后并发症发生率比较,差异无统计学意义（OR=1．81,95％C／：0．20～16．73,P〉0．05）。结论Roux—en—Y胃旁路术较胃袖状切除术在治疗2型糖尿病的疗效方面具有一定的优势。     

Roux—en—Y胃旁路术对2型糖尿病大鼠肾功能的影响

目的探讨Roux—en—Y胃旁路术对2型糖尿病大鼠肾功能的影响。方法采用高脂高糖饮食联合腹腔注射小剂量链脲佐菌素（streptozocin,STZ,35肛∥g）方法建立2型糖尿病大鼠模型。将造模成功的糖尿病SD大鼠分为3组：糖尿病组（8只）,假手术组（8只）,手术组（14只）;另取正常SD大鼠作为正常组（8只）。术前、术后8周检测大鼠空腹血糖,术前及术后4、8周测定血清BUN、Cr;术后8周取肾组织进行病理组织学观察,计算肾脏质量指数;免疫组织化学染色方法检测肾组织纤连蛋白、Ⅳ型胶原和TGF—B1的表达,采用Real—timePCR和Westernblot检测MMP-2、MMP-9mRNA和蛋白的表达。多组比较采用单因素方差分析,两两比较采用LSD检验。结果术后8周,糖尿病组大鼠血糖、BUN、Cr、肾脏质量指数分别为（15．9±1．6）mmol／L、（9．24-0．6）mmol／L、（44±4）~mol／L、（10．7±1．5）mg／g,手术组大鼠分别为（5．9±0．7）mmol／L、（6．64-0．4）mmol／L、（304-2）~mol／L、（8．6±0．6）mg／g,两组比较,差异有统计学意义（P〈0．05）。与正常组比较,糖尿病组、假手术组大鼠肾小球体积增大,系膜增生;手术组有明显改善。正常组大鼠肾脏皮质纤连蛋白、Ⅳ型胶原、TGF—B1免疫组织化学染色积分光密度值、MMP-2、MMP-9mRNA和蛋白的表达水平分别为664±23、864-5、524-6、1．00-4-0．04、644-4、1．004-0．20、48±5,糖尿病组大鼠分别为16654-44、7894-66、4594-35、0．52±0．13、514-6、0．364-0．05、384-4,假手术组大鼠分别为1701±55、7544-49、4254-42、0．544-0．19、484-5、0．434-0．09、394-4,手术组大鼠分别为11054-61、1954-11、1474-16、1．53±0．29、634-5、1．114-0．14、49-4-5,4组比较,差异均有统计学意义（F=1340．30,4982．50,2025．10,654．19,13．58,610．74,7．86,P〈0．05）。两两比较,差异均有统计学意义（P〈0．05）。结论Roux—eFl—Y胃旁路术可改善糖尿病大鼠肾功能,减少细胞外基质沉积,其作用机制可能与抑制TGF-β1表达和上调MMP-2、MMP-9mRNA和蛋白水平有关。     

袖状胃切除术治疗Ⅱ型糖尿病的进展

袖状胃切除术作为一种新型独立的减重术式,在世界范围得到了越来越多外科医师的青睐。但随着时代的推移,越来越多的对比研究发现袖状胃切除术在体重及血糖控制方面可能并不完美,本文现就目前国内外出现的袖状胃切除术结合旁路手术的新型术式作一简要综述。     

代谢手术治疗肥胖合并代谢综合征的Meta分析——袖状胃切除术与胃旁路术疗效比较

目的 比较袖状胃切除术及RouX-en-Y胃旁路术对肥胖伴有代谢综合征的近期疗效的循证支持.方法 以英文关键词“metabolic surgery”“bariatric surgery"“Roux-en-Y gastric bypass"“sleeve gastrectomy”“obesity”“T2DM”,及中文关键词“代谢手术”“减重手术”“胃旁路术”“袖状胃切除术”“肥胖”“2型糖尿病”等为检索词检索PubMed、EMBASE、Cochrane library、万方、CNKI数据库数据库检索自2011年1月-2016年6月间中英文袖状胃切除术及Roux-en-Y胃旁路术治疗合并肥胖的代谢综合征患者疗效相关文献,设立纳入与排除标准筛选文献,进行质量评价、提取数据和数据统计分析.结果 纳入Meta分析标准的文章有13篇,其中5篇为随机对照试验,8项病例对照研究涉及袖状胃切除术与Roux-en-Y胃旁路术疗效比较,共纳入病例18 850例:其中袖状胃切除术组2 559例,Roux-en-Y胃旁路术组16 291例.袖状胃切除术与Roux-en-Y胃旁路术术后1年2型糖尿病缓解率分别为78.7％和83.0％,二者差异无统计学意义(RR =0.94,95％CI:0.81 ～1.09,P＞0.05),但短期随访Roux-en-Y胃旁路术手术体重指数降低效果显著优于袖状胃切除术(MD=-2.03,95％ CI:-3.25 ～-0.81,P＜0.05).上述2种术式均能改善高血脂及高血压的发生率,但二者间差异并无统计学意义.结论 两种术式均为治疗肥胖合并代谢综合征的有效措施,均可降低包括T2DM、高血压、高血脂的发病率,并明显降低体重,Roux-en-Y胃旁路术治疗肥胖的疗效优于袖状胃切除术.     

腹腔镜胃旁路术与袖状胃切除术对肥胖患者肺功能影响的对比研究

目的:对比研究腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)与腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)对肥胖患者术后肺功能及氧合的影响。方法:选择2011年2月至2011年12月30例26~48岁的患者,其中男18例,女12例,按术式分为LRYGB组与LSG组,每组15例。分别于术前、术后24 h、术后48 h抽取患者股动脉血行血气分析,并记录动脉血氧分压(Pa O2)、二氧化碳分压(Pa CO2)、p H值;测定用力肺活量(forced vital capacity,FVC)、一秒用力呼气容量(forced expiratory volume in one second,FEV1)、最大呼气中段流量(maximal midexpiratory flow curve,MMF)等肺功能指标;应用视觉模拟评分法(visual analogue scale,VAS)对患者术后疼痛程度进行评估。结果:两组患者术前动脉血气、肺功能情况差异无统计学意义(P>0.05)。术后Pa O2、FVC、FEV1及MMF均较术前明显下降(P<0.05),p H、Pa CO2无明显变化(P>0.05)。术后24 h、48 h,LRYGB组Pa O2、FVC、FEV1及MMF明显低于LSG组(P<0.05);VAS评分两组差异无统计学意义(P<0.05)。结论:与LRYGB相比,LSG对肥胖患者肺功能、氧合影响较小,术后肺功能恢复快。     

胃旁路术对非肥胖型2型糖尿病大鼠糖代谢的影响

目的:观察胃旁路术对非肥胖型2型糖尿病大鼠(GK大鼠)糖代谢的影响.方法:GK大鼠20只,Wistar大鼠10只,随机分为GK手术组、GK假手术组和Wistar假手术组,每组10只;手术组行胃旁路术;测定术前1周及术后第1、2、4、8、12周各组体质量、空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平和血清胰岛素(INS)含量.结果:术后12周,GK手术组大鼠体质量由术前的(255.10±21.09)g上升到(364.55±25.73)g,FPG和HbA1c分别由术前的(11.36±1.14)mmol/L和(8.91±0.36)%下降到(8.36±0.62)mmol/L和(6.35±0.46)%,而血清INS由术前(32.76±2.37)μIU/mL上升到(55.14±5.45)μIU/mL.结论:胃旁路术可以明显降低GK大鼠的空腹血糖,改善糖代谢障碍.     

Roux-en—Y胃旁路术与胃束带术对2型糖尿病的疗效比较及其机制

目的探讨Roux—en-Y胃旁路术（RYGBP）与胃束带术（GB）对2型糖尿病（T2DM）大鼠的治疗效果及其机制。方法采用链脲佐菌素（STZ）制备大鼠T2DM模型。将40只成模大鼠分为RYGBP组、GB组、饮食控制组和对照组,每组10只。检测并比较手术前后空腹血糖、血浆胰岛素样生长因子-1（IGF-1）、血浆瘦素、血浆胰岛素水平．并记录各组大鼠进食量、体质量及存活情况。结果GB组术后空腹血糖下降,空腹血浆胰岛素升高．空腹血浆瘦素下降,体质量下降．与术前相比．差异均有统计学意义（P〈0．01）。RYGBP组空腹血糖术后空腹血糖下降,血浆IGF-1升高．空腹血浆胰岛素升高,空腹血浆瘦素下降,体质量下降,与术前相比,差异均有统计学意SL（P〈0．01）。但RYGBP组比GB组在空腹血糖和血浆胰岛素改善方面效果更为明显（P〈0．05,P〈0．01）。结论RYGBP对T2DM大鼠的治疗效果优于GB。     

保留不同胃容量的Rou-en—Y胃旁路术对糖尿病大鼠降糖效果的比较

目的观察保留不同胃容量的Roux-en-Y胃旁路术（RYGBP）对糖尿病大鼠降糖效果的比较。方法36只雄性Got0,Kakizaki（GK）大鼠随机分3组,分别为全胃切除RYGBP、胃大部切除RYGBP和保留全胃RYGBP组,每组12只。检测术前及术后1、3、6、12和24周各组大鼠体质量、日均摄食量和空腹血糖水平,测定术前、术后12和24周各组糖化血红蛋白水平及口服葡萄糖后0、30、60、120和180min血糖值,描制血糖值随时间变化曲线,计算糖耐量曲线下面积（AUC）。结果与术前比较．术后1周各组摄食量和体质量显著减少（P〈O．01）,术后3周胃大部切除RYGBP组和保留全胃RYGBP组大鼠摄食量及体质量较术后1周明显增加（氏0．01）,而全胃切除RYGBP组大鼠摄食量及体质量较其余两组低（P〈O．05）。术后24周。3组大鼠空腹血糖分别为（7．3±1．5）、（7．5±2．0）和（8．3±1_3）mmol／L,均低于术前水平[（13．2±1．6）、（13．6±2．5）和（12．9±2．0）mmol／L,P〈0．01]。而3组间比较,差异无统计学意义（P〉O．05）;糖化血红蛋白则分别为（6-3±1．3）％、（6．4±．2．0）％和（7．0±1．3）％,均低于术前[（10．2±．2．6）％、（9．6±2．5）％和（9．9±2．0）％,P〈0．01],而3组间比较,差异无统计学意义（P〉O．05）：3组术后糖耐量试验和AUC变化趋势与之类似。结论RYGBP可有效控制血糖水平．其降糖效果与胃容积的大小无明显联系。     

腹腔镜Roux-en-Y胃旁路术与腹腔镜袖状胃切除术对改善肥胖患者血脂的Meta分析

目的:比较腹腔镜Roux-en-Y胃旁路术(LRYGB)与腹腔镜袖状胃切除术(LSG)对肥胖症的减重效果及对血脂的影响。方法:检索相关数据库,以获取比较LRYGB与LSG治疗肥胖患者及改善血脂的相关中、英文文献,检索时间自建库至2022年9月,对纳入文献进行质量评价、提取数据及数据统计分析。结果:共纳入15篇文献,其中LRYGB组4 033例,LSG组4 859例。与LSG组相比,LRYGB组术后甘油三酯水平较低[MD=-0.19,95%CI(-0.33,-0.04),P<0.05],总胆固醇水平较低[MD=-0.61,95%CI(-0.95,-0.28),P<0.05],低密度脂蛋白水平较低[MD=-0.54,95%CI(-0.85,-0.24),P<0.05];两组术后体质指数[MD=-0.10,95%CI(-0.23,0.02),P>0.05]、高密度脂蛋白[MD=-0.12,95%CI(-0.40,0.15),P>0.05]、血脂异常缓解率[RR=1.14,95%CI(0.99,1.30),P>0.05]差异无统计学意义。结论:LRYGB与L...     

Comparison of the incidence of cholelithiasis after sleeve gastrectomy and Roux-en-Y gastric bypass: a meta-analysis

BackgroundBariatric surgery could increase the risk of cholelithiasis, although it is unclear whether the incidence rates of cholelithiasis are similar after different bariatric procedures.ObjectivesTo compare the incidence rates of cholelithiasis after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in people with obesity.SettingMeta-analysis of cohort studies.MethodsWe searched the PubMed and Web of Science databases for relevant studies before December 2020, and estimated the summary odds ratios (OR) and 95% confidence intervals (CI) using a random-effects model or fixed-effects model, according to the heterogeneity.ResultsIn total, 8 cohort studies were included in this meta-analysis, and 94,855 and 106,844 participants received SG and RYGB, respectively. Compared with those receiving RYGB, the summary results showed that participants receiving SG had a 35% lower rate of cholelithiasis (OR, .65; 95% CI, .49–.86). Also, the participants receiving SG had a significantly lower incidence of cholecystectomy than those receiving RYGB (OR, .54; 95% CI, .30–.99). In a subgroup analysis, SG was associated with a significantly lower incidence of subsequent cholelithiasis than RYGB in both Western and non-Western countries. SG led to a significantly lower incidence of cholelithiasis than RYGB only when the follow-up was <2 years instead of over 2 years.ConclusionParticipants receiving SG had a significantly lower incidence of cholelithiasis than those receiving RYGB, particularly within the first 2 years after the bariatric surgery.     

Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: A meta-analysis,meta-regression,and systematic review

Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally. However, it remains controversial which procedure provides better glycemic control. To identify predictors of glycemic control after SG versus RYGB, a systematic search of PubMed, EMBASE, and the Cochrane Library was conducted up to January 2017 for comparative studies with both SG and RYGB arms for the treatment of type 2 diabetes (T2D). A meta-analysis and systematic review was performed to evaluate glycemic control after SG versus RYGB with both short- and long-term follow-up. A meta-regression was performed to evaluate impacts of clinical indicators on glycemic control after SG versus RYGB. A total of 17 comparative studies involving 1160 patients were included. SG and RYGB achieved similar diabetic remission rates with both short- and long-term follow-up. However, SG provided lower endpoint glycosylated hemoglobin (A1C) after 1-year follow-up (mean deviation?=?.17, 95% confidence interval .03–.31, P?=?.02). When adjusted by baseline A1C, SG and RYGB provided similar percent delta A1C with 1-, 2-, 3-, and 5-year follow-up. The baseline body mass index, duration of T2D, preoperative fasting plasma glucose, and preoperative A1C had predictive value for glycemic control after SG, but only duration of T2D and preoperative A1C were correlated with that after RYGB. These findings showed that the choice of procedure between SG and RYGB predicts no better glycemic control. However, more factors should be considered when SG is recommended to a given patient with diabetes.     

Systematic review on sleeve gastrectomy or Roux-en-Y gastric bypass surgery for refractory gastroparesis

Management of refractory gastroparesis is challenging after diet, prokinetics, and long-term nutritional support have failed. In this review, the efficacy and safety of surgical interventions (sleeve gastrectomy and Roux-en-Y gastric bypass surgery) are evaluated systematically in patients with refractory gastroparesis. The PubMed, Embase, and Scopus databases were searched to identify relevant studies published up to June 2021. Outcome of interest was symptom improvement and gastric emptying. Nineteen studies with 222 refractory gastroparesis patients (147 Roux-en-Y gastric bypass, 39 sleeve gastrectomy, and 36 subtotal gastrectomy) were included. All studies reported symptom improvement postoperatively, particularly vomiting and nausea. Gastric emptying improved postoperatively in 45% up to 67% for sleeve gastrectomy and 87% for Roux-en-Y gastric bypass. The findings of our systematic review suggest that sleeve gastrectomy and Roux-en-Y gastric bypass surgery improve symptoms and gastric emptying in patients with refractory gastroparesis. Surgery may be effective as treatment for a small group of patients when all other therapies have failed.     

Metabolic comparison of one-anastomosis gastric bypass,single-anastomosis duodenal-switch,Roux-en-Y gastric bypass,and vertical sleeve gastrectomy in rat

Background

One-anastomosis gastric bypass (OAGB) and single-anastomosis duodenal switch (SADS) have become increasingly popular weight loss strategies. However, data directly comparing the effectiveness of these procedures with Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) are limited.

Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: A pilot study

BackgroundNutritional deficiencies are highly prevalent in obese patients. Bariatric surgery has been associated with adverse effects on homeostasis of significant vitamins and micronutrients, mainly after gastric bypass. The aim of the present study was to compare the extent of long-term postsurgical nutritional deficiencies between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).MethodsThis cross-sectional, pilot study included 95 patients who underwent RYGB or SG surgery with a mean follow-up of 4 years. Demographic, anthropometric, and biochemical parameters were compared according to the type of surgery.ResultsBoth types of surgery were associated with significant nutritional deficiencies. Vitamin B12 deficiency was significantly higher in patients with RYGB compared with SG (42.1% versus 5%, P = .003). The type of surgery was associated neither with anemia nor with iron or folate deficiency (SG versus RYGB: anemia, 54.2% versus 64.3%, P = .418; folate deficiency, 20% versus 18.4%, P = .884; iron deficiency, 30% versus 36.4%, P = .635).ConclusionDuring a mean follow up period of 4 years postRYGB or SG, patients were identified with several micronutrient deficiencies, including vitamin D, folate, and vitamin B12. SG may have a more favorable effect on the metabolism of vitamin B12 compared with RYGB, being associated with less malabsorption. Adherence to supplemental iron and vitamin intake is of primary significance in all cases of bariatric surgery.     

Anemia,iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis

BackgroundThe effective treatment of postoperative anemia and nutritional deficiencies is critical for the successful management of bariatric patients. However, the evidence for nutritional risk or support of bariatric patients remains scarce. The aims of this study were to assess current evidence of the association between 2 methods of bariatric surgery, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), and postoperative anemia and nutritional deficiencies.MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for English-language studies using a list of keywords. Reference lists from relevant review articles were also searched. In the authors’ meta-analysis, they included studies with a duration of>12 months, those comparing SG with RYGB, and those with available outcome data for postoperative anemia and iron and vitamin B₁₂ deficiencies. Of 36 potentially relevant studies, 9 met the inclusion criteria. Data were combined by means of a fixed-effects model or random-effects model.ResultsCompared with the SG group, the odds ratio for postoperative vitamin B₁₂ deficiency in the RYGB group was 3.55 (95% confidence interval, 1.26–10.01; P<.001). In the subgroup analysis, studies in which prophylactic iron or vitamin B₁₂ was administered lost significance in the odds ratio for postoperative vitamin B₁₂ deficiency.ConclusionThe authors’ findings suggest that SG is more beneficial than RYGB with regard to postoperative vitamin B₁₂ deficiency risk, whereas the 2 methods are comparable with regard to the risk of postoperative anemia and iron deficiency. Postoperative prophylactic iron and B₁₂ supplementation, in addition to general multivitamin and mineral supplementation, is recommended based on the comparable deficiency risk of the 2 methods as indicated by subgroup analysis.     

Roux-en-Y胃旁路术对2型糖尿病大鼠肝脏糖异生的影响

目的探讨Roux-en-Y胃旁路术对2型糖尿病大鼠肝脏糖异生的影响及意义。方法将40只GotoKakizaki（GK）大鼠按随机数字表法分为Rollx-en-Y胃旁路术组（A组,20只）和假手术组（B组,20只）。分别于术前及术后1、2、4周行口服葡萄糖耐量实验（OGYr）。并记录体质量。于术前及术后第4周测定两组大鼠糖化血红蛋白（HbAlc）水平。术后第4周处死大鼠获取肝脏组织,采用反转录聚合酶链反应和Westernblot技术检测肝脏组织葡萄糖6磷酸酶（G-6-P）、磷酸烯醇式丙酮酸激酶（PEPCK）的mRNA及蛋白相对表达量。结果术后1、2、4周,A组大鼠平均空腹血糖分别为6．5、4．9和4．7mmol／L,而B组分别为10-3、10．4和12．5mmol／L。两组比较差异均有统计学意义（均P〈0．05）;A组灌胃后2h血糖分别平均为8．3、6．4和5．5mmol／L,B组为21．4、23．8和24．7mmol／L,两组比较差异均有统计学意义（均P〈0．05）。A组术后第4周HbAlc为（6．8±1．0）％,低于B组的（7．9±0．8）％（P〈0．05）。A组术后4周肝脏G-6-P和PEPCK的mRNA相对表达较B组分别降低了21．0％和25．9％,蛋白表达水平也相应降低（均P〈0．05）。PAS染色示肝脏糖原沉积明显增多。结论Roux-en-Y胃旁路术后肝脏糖异生关键酶的mRNA相对表达和蛋白含量明显降低。肝脏糖异生减少．这可能是该术式的降糖机制之一。     

Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for complications: outcomes from a tertiary referral center in the Middle East

BackgroundComplications after sleeve gastrectomy (SG) unfortunately lead a subset of patients to require revisional surgery, including conversion to Roux-en-Y gastric bypass (RYGB).ObjectivesWe aimed to describe the indications for conversion and perioperative outcomes in this subset of patients.SettingAcademic hospital, Abu Dhabi, United Arab Emirates.MethodsAll patients undergoing conversion from SG to RYGB from September 2015 to December 2018 were retrospectively reviewed. Patients who underwent conversion solely for weight recidivism were excluded from analysis.ResultsForty-seven patients underwent conversion to RYGB due to complications from SG. The cohort was 76.5% female with a mean age of 39 years and median body mass index of 34 kg/m². The median time between SG and RYGB was 36 months. Indications warranting conversion included mechanical complications (n = 24, 51.1%), intractable reflux (n = 21, 44.7%), and fistula (n = 2, 4.2%). Preoperative mechanical abnormalities included hiatal hernia (n = 13, 27.7%), helical twist (n = 10, 21.3%), sleeve stenosis/stricture (n = 5, 10.6%), fistula (n = 2, 4.2%), and leak (n = 1, 2.1%). Each conversion was completed with a laparoscopic approach, with a median length of stay of 3 days. Four patients (8.5%) experienced complications within 30 days, including 2 patients (4.2%) with superficial surgical site infection, 1 patient each (2.1%) with gastrointestinal hemorrhage and anastomotic leak. There were no mortalities at a median follow-up of 17 months.ConclusionIn this series, representing the largest reported single-center experience in the Middle East, conversion of SG to RYGB was safe and effective for the treatment of symptoms and mechanical complications after SG.