Conversion metabolic bariatric surgery after sleeve gastrectomy: an MBSAQIP analysis

Conversion Metabolic Bariatric Surgery (cMBS) is increasingly common despite the effectiveness of primary bariatric surgery for obesity and the medical conditions associated with obesity.

This study used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, a retrospective national database, to analyze trends in cMBS following sleeve gastrectomy and compare postoperative outcomes among different types of conversions.

American College of Surgeons MBSAQIP Centers of Excellence across the United States.

A retrospective analysis of the 2020-2021 MBSAQIP database was performed, inclusive of patients who underwent cMBS from sleeve gastrectomy to biliopancreatic diversion with duodenal switch (BPD/DS), Roux-en-Y gastric bypass (RYGB), Roux-en-Y distal gastric bypass (RYGB-d), single-anastomosis duodeno-ileal bypass sleeve (SADI-s), and one-anastomosis gastric bypass (OAGB). Descriptive analyses and multivariable logistic regression models were performed to analyze 30-day outcomes.

Out of 18,179 conversions from sleeve gastrectomy, 1,153 (6.3%) were to BPD/DS, 15,425 (85%) to RYGB, 685 (3.7%) to RYGB-d, 723 (3.9%) to SADI-s, and 193 (1.1%) to OAGB. Common indications included gastroesophageal reflux disease (GERD) and inadequate weight loss or weight gain. Minor complications were significantly lower (p = 0.012) for cMBS to BPD/DS and SADI-s (1.4-1.5%), compared with RYGB, RYGB-d, and OAGB (2.5-2.8%), with no statistically significant differences in major complications (p = 0.41). Readmission rates were higher for cMBS to RYGB, RYGB-d, and OAGB (19-20%), compared to BPD/DS and SADI-s (14-15%) (p < 0.001).

cMBS are increasingly needed due to GERD or suboptimal weight outcomes. While major complications appear comparable across conversion types, RYGB, RYGB-d, OAGB have higher rates of readmissions and minor complications.