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Updated: Jun 9, 2025
Author Spotlight: Recent Advancements in Reoperative Foregut Surgery
Published on: September 22, 2023
National trends in using revisional surgeries post-sleeve gastrectomy due to reflux and weight recurrence: a matched
Thomas H Shin1, Pourya Medhati2, Vasundhara Mathur2
1Laboratory for Surgical and Metabolic Research, Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of General Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Background:
Several options exist for surgical conversion after sleeve gastrectomy (SG), but a definitive safety profile for each option by indication for conversion remains unclear.
Objectives:
To determine and compare 30-day risk profiles of SG conversion to Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy (SADI).
Methods:
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database entries from 2020 to 2022 were used to identify 25,760 adult patients who underwent SG conversion to RYGB, BPD-DS, or SADI. Subgroup analyses were performed among 6106 conversions completed for weight-related complications (RYGB: 3053 patients; BPD-DS: 1826 patients; SADI: 1227 patients). Multivariable analysis and 1:1 nearest-neighbor matching were used to further characterize the 30-day risk profile of each conversion.
Results:
Patients with RYGB conversions had a lower preoperative body mass index compared with those with BPD-DS + SADI conversions (39.8 versus 46.1, P < .001) and significantly lower rates of medical comorbidities. The distribution of conversion indication for each MBS configuration varied, where most RYGB conversions were for reflux (56.1%) whereas most BPD-DS + SADI conversions were for weight-related complications (87.3%; P < .001). On 1:1 matched analysis of conversions for weight recurrence, odds of 30-day complications (odds ratio .73, P = .019) and readmission (odds ratio .77, P = .031) were lower in BPD-DS + SADI conversions compared with RYGB. There were no significant differences in odds of 30-day reintervention or reoperation between conversion to RYGB and BPD-DS + SADI. Major differing drivers of complications between conversion types included hemorrhage (RYGB 1.98% versus BPD-DS + SADI .87%; P = .001).
Conclusions:
For weight recurrence after SG, conversion to BPD-DS + SADI does not have greater 30-day complications than RYGB and may be a safe conversion option.
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