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. 2023 Sep 15;12(18):5975.
doi: 10.3390/jcm12185975.

Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database

Karl Hage  1 , Juan S Barajas-Gamboa  2 , Gustavo Romero-Velez  3 , Matthew Allemang  3 , Salvador Navarrete  3 , Ricard Corcelles  3 , John Rodriguez  2 , Omar M Ghanem  1 , Matthew Kroh  3 , Jerry T Dang  3
Affiliations

Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database

Karl Hage et al. J Clin Med. .

Abstract

Introduction: The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal switch (BPD-DS). We aimed to compare serious complications and mortality rates between these procedures within 30 days.

Methods: Using the 2020 and 2021 MBSAQIP databases, we identified patients who underwent a conversion from SG to RYGB, SADI, or BPD-DS. We performed a multivariable logistic regression to assess predictors of 30-day complications and mortality.

Results: Among 7388 patients (77.6% RYGB, 8.7% SADI, 13.7% BPD-DS), those undergoing SADI and BPD-DS had higher preoperative body mass index. Conversion reasons included WR (63.0%) and IWL (37.0%). SADI and BPD-DS patients had longer operative times (p < 0.001) and higher leak rates (p = 0.001). Serious complications, reoperations, readmissions, and 30-day mortality were similar across groups. Conversion procedure type was not an independent predictor of complications.

Conclusion: RYGB was the most performed conversional procedure after SG. The study indicated a similar safety profile for revisional RYGB, SADI, and BPD-DS, with comparable 30-day complications and mortality rates. However, SADI and BPD-DS patients had longer operative time and higher leak rates.

Keywords: bariatric conversions; conversion safety; duodenal switch; gastric bypass; sleeve gastrectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flow chart. SG, primary sleeve gastrectomy; RYGB, conversion from sleeve gastrectomy to Roux-en-Y gastric bypass; SADI, conversion from sleeve gastrectomy to single-anastomosis duodeno-ileal bypass; BPD-DS, conversion from sleeve gastrectomy to biliopancreatic diversion with duodenal switch.
Figure 2
Figure 2
Indication for revisional surgery after sleeve gastrectomy. WR: weight recurrence; IWL: inadequate weight loss; RYGB: Roux-en-Y gastric bypass; SADI: single anastomosis duodeno-ileal bypass; BPD-DS: biliopancreatic diversion with duodenal switch.
See this image and copyright information in PMC

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