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. 2020 Oct;34(10):4422-4428.
doi: 10.1007/s00464-019-07219-6. Epub 2019 Oct 21.

Conversions of Roux-en-Y gastric bypass to duodenal switch (SADI-S and BPD-DS) for weight regain

Rena C Moon  1 , Layth Alkhairi  1 , Alyssa Jameson Wier  1 , Andre F Teixeira  1 , Muhammad A Jawad  2
Affiliations

Conversions of Roux-en-Y gastric bypass to duodenal switch (SADI-S and BPD-DS) for weight regain

Rena C Moon et al. Surg Endosc. 2020 Oct.

Abstract

Background: Duodenal switch is a choice of conversion when patients fail to lose or regain weight after Roux-en-Y gastric bypass (RYGB). This study aims to evaluate the effectiveness and safety of duodenal switch as a secondary operation for patients who presented with insufficient weight loss or weight regain after a RYGB.

Methods: A retrospective chart review was performed on 15 patients who underwent a conversion of RYGB to single anastomosis duodeno-ileal bypass with sleeve (SADI-S) or biliopancreatic diversion with duodenal switch (BPD-DS) due to weight regain between December 31, 2013 and October 31, 2018. For the body mass index (BMI) analysis, the multilevel model for change was used.

Results: Of 15 patients, 10 underwent a conversion to SADI-S, and 5 underwent a conversion to BPD-DS. Also, 7 patients underwent the conversion in two-stages, while 8 did as single-stage. One patient had a duodenal stump leak after SADI-S, and another patient had a sleeve leak after BPD-DS. One patient underwent a reoperation to increase the common channel 20 months after the conversion to BPD-DS due to malnutrition. There was no mortality. Mean percentage of total weight loss (TWL) was 18.4% at 6 months, 25.0% at 12 months, 26.4% at 18 months, and 25.7% at 24 months after the conversion. The rate of decrease in BMI was slower in SADI-S patients than in BPD-DS patients (p < 0.01), adjusting for preoperative BMI.

Conclusion: Conversions of RYGB to SADI-S and BPD-DS can provide significant additional weight loss. However, complications and malnutrition can develop after the conversion, and further research is needed for evaluating safety.

Keywords: BPD-DS; Conversion; Duodenal switch; Gastric bypass; SADI-S; Weight regain.

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References

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