Conversion bariatric surgery after sleeve gastrectomy: results and resolution of comorbidities. Experience of 209...

Sleeve gastrectomy (SG) has become the most frequently performed bariatric procedure worldwide, however a substantial proportion of patients ultimately require conversion surgery due to complications or suboptimal outcomes. Comprehensive data on the results of the various conversion procedures remain limited.

To evaluate the indications, surgical techniques, safety profile, comorbidity resolution, and effectiveness of conversion bariatric surgery after SG.

Retrospective analysis of 209 patients who underwent conversion surgery after SG at Bellvitge University Hospital between 2015 and 2024. Primary outcomes included weight-loss results, complication rates, and comorbidity resolution. Secondary outcomes included length of hospital stay and achievement of Textbook Outcome.

Mean age was 48.1 ± 7.8 years. Median maximum BMI was 54.8 kg/m² (IQR 47.7-60.6). Indications were weight regain (55.5%), insufficient weight loss (32.5%), and GERD (12.0%). Conversion procedures included DS (48.3%), SADI-S (40.7%), and RYGB (11.0%). Overall complication rate was 7.2% with no mortality. Median total weight loss from maximum weight was 36.5% (IQR 27.9-45.0) and from pre-conversion was 14.0% (IQR 6.6-23.1 %). Hypertension prevalence decreased from 40.2% post-SG to 15.8% post-conversion (60.7% improvement). Dyslipidemia improved from 24.4% to 7.2% (70.6% improvement). Type 2 diabetes decreased from 25.4% to 11.5% (54.7% improvement). Obstructive sleep apnea decreased from 47.4% to 17.2% (63.6% improvement).

Conversion surgery after SG is safe and effective, achieving excellent outcomes. Hypoabsorptive procedures showed superior metabolic results while maintaining acceptable complication rates.