Weight recidivism after RYGB can be seen in approximately 25% of patients. Surgical management options include revision of RYGB and conversion to DS/SADI. Using recentlyincluded revision surgery variables in the MBSAQIP database we compared the safety andefficacy of RYGB revision with conversion to DS/SADI.
An analysis of the 2020 MBSAQUIP PUF revealed 1421 patients who underwent revision ofRYGB (n=1255) or conversion from RYGB to DS/SADI (n=166) for inadequate weight loss orweight regain. Patient characteristics, preop BMI, OR time, 30 day complications and weightloss was compared between groups.
When compared with the revision RYGB group, the DS/SADI conversion group had highermean BMI (47.50 vs 42.73, p<0.001) and longer operative time (209.05 vs 133.35 min,p<0.001). DS/SADI had higher rates of any complication compared to revision RYGB (22.3 vs5.6%, p<0.001), including higher 30 day readmission rates (16.27 vs 5.5%, p<0.001),reoperation within 30 days (9.0 vs 2.9%, p<0.001), VTE (3.01 vs 0.08%, p<0.001), ICU admission(8.4 vs 0.7%, p<0.001) anastomotic leak (7.8 vs 0.4%, p<0.001), SSI (11.25 vs 2.63%, p<0.001)and death (0.6 vs 0.0%, p<0.001). The DS/SADI group had more weight loss at 30 days (46.65vs 29.21lbs, p=0.0045).
These data suggest that conversion of RYGB to DS/SADI is associated with significantly higherrates of postoperative complications when compared with revision RYGB and should beconsidered when counseling patients on surgical options for weight recidivism after RYGB.