Conversion of gastric sleeve to Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch: safe and viable options

Nov 22, 2022Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Changing from stomach sleeve surgery to bypass or diversion surgeries: safe and practical options

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Abstract

A total of 6020 patients underwent sleeve gastrectomy conversion to either Roux-en-Y gastric bypass or biliopancreatic diversion and duodenal switch.

There was no statistically significant difference in mortality between the two conversion methods (0.12% for RYGB vs. 0% for BPD/DS).
Complication rates were similar for both conversions, with RYGB at 6.5% and BPD/DS at 5.1%.
Anastomotic leak occurred more frequently with BPD/DS (1.2%) compared to RYGB (0.5%).
BPD/DS was associated with a lower likelihood of requiring dehydration treatments (2.2% for BPD/DS vs. 4.2% for RYGB).
Readmission rates were lower for BPD/DS (5.4%) than for RYGB (7.3%).
Conversion from sleeve gastrectomy to either method may be safer than previously reported, with outcomes only slightly higher than primary weight loss surgery.

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BACKGROUND: Sleeve gastrectomy (SG) remains the most performed bariatric surgery. As numbers of SG increase, so do the numbers of patients requiring conversion for insufficient weight loss or weight regain. However, the literature has cited complication rates as high as 30% for reoperative bariatric surgery.

OBJECTIVE: With the recent inclusion of conversion surgery variables in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared the safety and efficacy of SG conversion to Roux-en-Y gastric bypass (RYGB) versus biliopancreatic diversion and duodenal switch (BPD/DS).

SETTING: MBSAQIP database.

METHODS: Analysis of the 2020 MBSAQIP Participant Use Files 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, and weight loss.

RESULTS: There was no statistically significant difference in mortality (.12% versus 0%) or; complication rate (6.5% versus 5.1%) with SG conversion to RYGB or BPD/DS. There was a statistically significant difference in anastomotic leak (.5% versus 1.2%, P = .024). Interestingly, BPD/DS was less likely to require dehydration treatments (4.2% versus 2.2%, P = .009) and had fewer readmissions within 30 days (7.3% versus 5.4%, P = .043).

CONCLUSIONS: Complication rates after conversion of SG to RYGB or BPD/DS may be significantly lower than previously reported and only slightly higher than after primary weight loss surgery. SG conversion to either RYGB or BPD/DS remain safe, viable options for patients who had insufficient weight loss or regain, and BPD/DS may be the better option in the appropriate patient.

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Conversion of gastric sleeve to Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch: safe and viable options

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