Is conversion to duodenal switch after Roux-en-Y gastric bypass safe? Short-term outcomes review

Oct 28, 2024Surgical endoscopy

Is switching to duodenal switch surgery after gastric bypass safe? A review of short-term results

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Abstract

Conversion from Roux-en-Y gastric bypass to duodenal switch is associated with higher rates of postoperative complications.

Mean body mass index (BMI) was higher in the duodenal switch group (47.5) compared to the revision group (42.7).
Operative time was significantly longer for duodenal switch (209.1 minutes) than for revision of Roux-en-Y gastric bypass (133.4 minutes).
The duodenal switch group experienced higher overall complication rates (22.3%) compared to the revision group (5.58%).
30-day readmission rates were significantly higher for duodenal switch (16.3%) versus revision (5.50%).
The duodenal switch group had notably higher rates of venous thromboembolism (3.01% vs 0.08%) and anastomotic leaks (7.83% vs 0.40%).
Mortality rates were recorded at 0.60% for the duodenal switch group, while there were no deaths in the revision group.

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BACKGROUND: Weight regain after Roux-en-Y gastric bypass (RYGB) can be seen in approximately 20% of patients. Surgical management options include revision of RYGB and conversion to duodenal switch (DS). Using recently included revisional surgery variables in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared the safety and efficacy of RYGB revision versus conversion to DS.

METHODS: An analysis of the 2020 MBSAQIP Participant Use Data File (PUF) revealed 1421 patients who underwent revision of RYGB (n = 1255) or conversion from RYGB to DS (n = 166) for inadequate weight loss or weight regain. Patient characteristics, preoperative body mass index (BMI), operating room (OR) time, and 30-day complications were compared between groups.

RESULTS: When compared with the revision RYGB group, the DS group had higher mean BMI (47.5 vs 42.7, p < 0.001) and longer operative time (209.1 vs 133.4 min, p < 0.001). DS had higher rates of any complication compared to revision RYGB (22.3 vs 5.58%, p < 0.001). DS had higher 30-day readmission rates (16.3 vs 5.50%, p < 0.001), reoperation within 30 days (9.04 vs 2.87%, p < 0.001), venous thromboembolism (VTE) (3.01 vs 0.08%, p < 0.001), intensive care unit (ICU) admission (8.43 vs 0.72%, p < 0.001), anastomotic leak (7.83 vs 0.40%, p < 0.001), surgical site occurrence (SSO) (11.5 vs 2.71%, p < 0.001), and death (0.60 vs 0%, p < 0.001).

CONCLUSION: This short-term data suggests that conversion of RYGB to DS is associated with higher rates of postoperative complications when compared with revision of RYGB. Given the complexity of the procedure, it is best performed by experienced surgeons with careful consideration given to appropriate patient selection and only after extensive patient counseling on associated risks and complications.

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Is conversion to duodenal switch after Roux-en-Y gastric bypass safe? Short-term outcomes review

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