Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Prevalence, and Safety

Mar 16, 2023Obesity surgery

Reasons, frequency, and safety of changing sleeve gastrectomy to Roux-en-Y gastric bypass

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Abstract

In a large cohort study, 7.2% of patients undergoing conversion from sleeve gastrectomy to Roux-en-Y gastric bypass experienced serious complications.

Conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) was performed in 13,432 patients, representing 13.7% of the total cohort.
The most common reasons for conversion were gastroesophageal reflux disease (GERD) at 55.3% and weight regain at 24.4%.
Patients who underwent SG-RYGB had longer operative times, averaging 145 minutes compared to 125 minutes for primary RYGB.
The rate of serious complications was higher in the SG-RYGB group at 7.2% compared to 5.0% in the primary RYGB group.
Specific complications included higher rates of anastomotic leak (0.5% vs. 0.4%), bleeding (2.0% vs. 1.6%), and reoperation (3.0% vs. 1.9%).
No significant difference in mortality rates was observed between SG-RYGB and P-RYGB groups, with both at 0.1%.

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BACKGROUND: Sleeve gastrectomy (SG) frequently requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disease (GERD) or weight recurrence. Current evidence evaluating the safety of conversion from SG to RYGB and its indications is limited to single centers.

METHODS: The objective was to determine the rate of serious complications and mortality of conversion of SG to RYGB (SG-RYGB) compared to primary RYGB (P-RYGB). This was a retrospective analysis of the MBSAQIP database which includes 30-day outcomes. Individuals undergoing P-RYGB or SG-RYGB were included. Multivariable logistic regression was performed to determine if revisional surgery was an independent predictor of serious complications or mortality.

RESULTS: In 2020 and 2021, 84,543 (86.3%) patients underwent P-RYGB and 13,432 (13.7%) underwent SG-RYGB. SG-RYGB cohort had lower body mass index, lower rates of diabetes and hypertension, and higher rates of GERD. GERD was the most common indication for revision (55.3%) followed by weight regain (24.4%) and inadequate weight loss (12.7%). SG-RYGB had longer operative times (145 vs. 125 min, p < 0.001) and a higher rate of serious complications (7.2 vs. 5.0%, p < 0.001). This included higher rates of anastomotic leak (0.5 vs. 0.4%, p = 0.002), bleeding (2.0 vs. 1.6%, p < 0.001), and reoperation (3.0 vs. 1.9%, p < 0.001) but not death (0.1 vs. 0.1%, p = 0.385). On multivariable analysis, SG-RYGB was independently predictive of serious complications (OR 1.21, 95%CI 1.12 to 1.32, p < 0.001) but not mortality (p = 0.316).

CONCLUSIONS: While SG-RYGB is safe with a low complication rate, SG-RYGB was associated with a higher rate of serious complications compared to P-RYGB.

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Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Prevalence, and Safety

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