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Background

Sleeve gastrectomy (SG) remains the most commonly performed bariatric surgery. As numbers of SG increase, so do patients who require revision for insufficient weight loss or weight regain. However, the literature has cited complication rates as high as 30% for reoperative bariatric surgery. With the recent inclusion of revision surgery variables in the MBSAQIP database, we are able to compare the safety and efficacy of SG conversion to Roux-en-Y Gastric Bypass (RYGB) vs Biliopancreatic Diversion and Duodenal Dwitch (BPD/DS).

Methods

An analysis of the 2020 MBSAQIP PUF revealed 6020 patients who underwent SG conversion to RYGB (5348) and BPD/DS (672). We examined 30 day outcomes including death, anastomotic leak, readmission, any complication, dehydration treatment, and weight loss.

Results

There was no statistically significant difference in mortality (0.12% vs 0%) or complication rate (6.5 vs 5.1 %) with SG conversion to RYGB or BPD/DS. There was a statistically significant difference in anastomotic leak (0.5% vs 1.2% p=0.024). Interestingly, BPD/DS was less likely to require dehydration treatments (4.2 vs 2.2% p=0.009) and had less readmissions after 30 days (7.3% vs 5.4% p=0.043). BPD/DS afforded more weight loss at 30 days (28.41 lbs vs 43.78 lbs p=0.001).

Conclusions

The complication rates after conversion of SG to RYGB or BPD/DS may be significantly lower than previously reported and only slightly higher than complication rates after primary weight loss surgery. SG conversion to either RYGB or BPD/DS remain safe, viable options for those patients who had insufficient weight loss or regain.