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Conversion metabolic bariatric surgery after sleeve gastrectomy: an MBSAQIP analysis.
Ruben D Salas-Parra1, Manuel Beltran Del Rio2, Katerina Jou2
1Department of Surgery Northwell, New Hyde Park, NY, USA. rsalasparra@northwell.edu.
Surgical Endoscopy
|January 6, 2026
Summary
Conversion metabolic bariatric surgery (cMBS) is rising, often after sleeve gastrectomy. Biliopancreatic diversion with duodenal switch (BPD/DS) and single-anastomosis duodeno-ileal bypass sleeve (SADI-s) show lower complication and readmission rates compared to other conversion types.
Area of Science:
- Bariatric Surgery
- Metabolic Surgery
- Surgical Outcomes
Background:
- Conversion metabolic bariatric surgery (cMBS) is an emerging procedure for managing obesity and associated comorbidities.
- Primary bariatric surgery remains effective, yet cMBS is increasingly utilized.
Purpose of the Study:
- To analyze trends in cMBS following sleeve gastrectomy.
- To compare postoperative outcomes across different cMBS procedures using national database data.
Main Methods:
- Retrospective analysis of the 2020-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
- Inclusion of patients converting from sleeve gastrectomy to BPD/DS, RYGB, RYGB-d, SADI-s, or OAGB.
- Statistical analysis including descriptive statistics and multivariable logistic regression for 30-day outcomes.
Main Results:
- Out of 18,179 sleeve gastrectomy conversions, RYGB was most common (85%), followed by BPD/DS (6.3%), SADI-s (3.9%), RYGB-d (3.7%), and OAGB (1.1%).
- Common indications for cMBS included GERD and inadequate weight loss or regain.
- BPD/DS and SADI-s had significantly lower minor complication rates (1.4-1.5%) and readmissions (14-15%) compared to RYGB, RYGB-d, and OAGB (2.5-2.8% and 19-20%, respectively).
Conclusions:
- cMBS is increasingly necessary for managing GERD and suboptimal weight outcomes post-sleeve gastrectomy.
- While major complication rates were similar across conversion types, RYGB, RYGB-d, and OAGB were associated with higher rates of readmissions and minor complications.
