Sleeve gastrectomy (SG) remains the most performed bariatric surgery. As numbers of
SG increase, so do the numbers of patients requiring conversion for insufficient weight
loss or weight regain. However, the literature has cited complication rates as high
for reoperative bariatric surgery.
With the recent inclusion of conversion surgery variables in the Metabolic and Bariatric
Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared
the safety and efficacy of SG conversion to Roux-en-Y gastric bypass (RYGB) versus
biliopancreatic diversion and duodenal switch (BPD/DS).
Analysis of the 2020 MBSAQIP Participant Use Files revealed 6020 patients
who underwent SG conversion to RYGB (5348) and BPD/DS (672). We examined 30-day outcomes
including death, anastomotic leak, readmission, any complication, dehydration, and
There was no statistically significant difference in mortality (.12% versus 0%) or;
complication rate (6.5% versus 5.1%) with SG conversion to RYGB or BPD/DS. There was
a statistically significant difference in anastomotic leak (.5% versus 1.2%, P = .024).
Interestingly, BPD/DS was less likely to require dehydration treatments (4.2% versus
2.2%, P = .009) and had fewer readmissions within 30 days (7.3% versus 5.4%, P = .043).
Complication rates after conversion of SG to RYGB or BPD/DS may be significantly lower
than previously reported and only slightly higher than after primary weight loss surgery.
SG conversion to either RYGB or BPD/DS remain safe, viable options for
patients who had insufficient weight loss or regain, and BPD/DS may be the better
option in the appropriate patient.