Background

Conversion from sleeve gastrectomy (VSG) to biliopancreatic diversion with duodenal switch (BPD-DS) is a safe and proven alternative for inadequate weight loss or weight recurrence. We retrospectively evaluated our experience with VSG to BPD-DS over the last 9 years and studied the influence of various clinical and technical elements on weight loss.

Methods

Four surgeons performed elective conversion of VSG to BPD-DS on 140 patients at a single community institution from 2015 to 2023. Electronic health records were reviewed retrospectively for technique, changes in weight, nutritional status, and postoperative outcomes.

Results

108 of 140 patients had follow-up data at 1 year or beyond. 83 patients had re-sleeve (RS) performed concurrently with conversion to BPD-DS. At 1 year, the RS group had 26% total weight loss (TWL) and 60% excess weight loss (EWL) compared to 20% TWL and 44% EWL in the no re-sleeve (NRS) group. At last follow-up (2-8 years, avg 5 years), no significant difference in %TWL or %EWL in the RS vs. NRS group was observed. Comparing the use of 100 cm common channel (CC) to 150 cm CC (fixed alimentary limb 300 cm), the 100 cm CC resulted in greater %TWL at 12 months and last follow-up patients (p<0.01). Hypoalbuminemia was the only nutritional deficiency affected by CC length.

Conclusions

Conversion to BPD-DS is an effective option for sleeve revision. RS improves weight loss at one year but shows no long-term difference. Shorter CC leads to greater %TWL.