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Conversion of gastric sleeve to Roux-en-Y gastric bypass and biliopancreatic diversion/duodenal switch: safe and viable options

Published:November 01, 2022DOI:https://doi.org/10.1016/j.soard.2022.10.024

      Abstract

      Background

      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 as 30%
      for reoperative bariatric surgery.

      Objective

      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).

      Setting

      MBSAQIP database.

      Methods

      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 weight loss.

      Results

      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).

      Conclusions

      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.

      Keywords

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      Linked Article

      • Comment on: Insurance-mandated weight management program completion before bariatric surgery provides no long-term clinical benefit
        Surgery for Obesity and Related Diseases
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          By 2030, 1 in 2 American adults is projected to have obesity and 1 in 4 clinically severe obesity. Obesity represents a serious public health issue because it is a major risk factor for many major, noncommunicable diseases, such as type 2 diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, and cancer, and independently predicts overall mortality. The burden of obesity on medical spending is also significant, with $1861 in excess annual medical costs per adult with obesity and $3097 per adult with severe obesity—accounting for $173 billion annually in the United States [1].
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