Conversion of gastric sleeve to Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch: safe and viable options |
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Institution: | 1. Department of Surgery, Brown University, Providence, Rhode Island;2. Division of Bariatric Surgery, Department of General Surgery, Brown University, Providence, Rhode Island;1. Keegan-University of Chicago, Pritzker School of Medicine, 924 E. 57th Street, Chicago, IL 60637, USA;2. Breast Surgery, True Family Women’s Cancer Center, Swedish Cancer Institute, Seattle, WA, USA;3. Department of Surgery, New York University Grossman School of Medicine, NYC Health and Hospitals/Bellevue, New York, NY, USA;4. NYU Langone Health''s Institute for Excellence in Health Equity, 180 Madison Avenue, New York, NY, USA |
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Abstract: | BackgroundSleeve 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.ObjectiveWith 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).SettingMBSAQIP database.MethodsAnalysis of the 2020 MBSAQIP Participant Use Files revealed 6020 patientswho 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.ResultsThere 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).ConclusionsComplication 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 forpatients who had insufficient weight loss or regain, and BPD/DS may be the better option in the appropriate patient. |
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Keywords: | Bariatric surgery Conversion bariatric surgery Reoperative Roux-en-Y gastric bypass Duodenal switch Biliopancreatic diversion and duodenal switch Sleeve gastrectomy Gastric sleeve Metabolic and Bariatric Surgery Accreditation and Quality Improvement |
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