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

Area of Science:

• Bariatric Surgery
• Surgical Outcomes
• Metabolic Surgery

Background:

• Weight regain affects approximately 20% of patients post-Roux-en-Y gastric bypass (RYGB).
• Surgical options for weight regain include RYGB revision or conversion to duodenal switch (DS).

Purpose of the Study:

• To compare the safety and efficacy of RYGB revision versus conversion to DS for weight regain.
• Utilize the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for analysis.

Main Methods:

• Analysis of the 2020 MBSAQIP Participant Use Data File (PUF).
• Compared 1255 patients undergoing RYGB revision with 166 patients converted from RYGB to DS.
• Evaluated patient characteristics, preoperative BMI, operative room time, and 30-day complications.

Main Results:

• The DS group had higher mean BMI (47.5 vs 42.7) and longer operative time (209.1 vs 133.4 min).
• DS conversion was associated with significantly higher rates of overall complications (22.3% vs 5.58%).
• Specific complications including readmission, reoperation, VTE, ICU admission, anastomotic leak, SSO, and death were higher in the DS group.

Conclusions:

• Conversion from RYGB to DS is linked to increased short-term postoperative complications compared to RYGB revision.
• Due to its complexity, DS conversion requires experienced surgeons, careful patient selection, and thorough risk counseling.