Background

Despite the popularity of laparoscopic sleeve gastrectomy (LSG) as an initial weight loss procedure, there are well-documented risks of recurrent weight gain (RWG) and gastroesophageal reflux disease (GERD), necessitating conversion to Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD), or single-anastomosis duodenoileal bypass (SADI).

Methods

Using the 2020-2022 MBSAQIP registry, we analyzed patients following LSG conversion to RYGB or SADI/BPD due to RWG or GERD. To identify the safest conversion option for patients with RWG, we performed 1:1 matching for demographics and preoperative comorbidities and compared their 30-day post-operative outcomes following conversion to RYGB and BPD/SADI.

Results

Overall, 13,765 and 11,381 patients underwent LSG conversion due to GERD and RWG, respectively. GERD-related revisions primarily included RYGB, while in RWG, 2,474 (21.7%) had SADI/BPD, while remaining underwent RYGB. Among individuals with RWG, matched SADI/BPD and RYGB groups (2,096 patients in each) demonstrated higher post-operative occurrence in RYGB (3.6% vs. 2.5%, p=.04). This increased risk among RYGB patients was mainly driven by intra-op/post-op blood transfusion (1.4% vs. 0.4%, p<.001) and superficial surgical site infection (1% vs. 0.2%, p=.003). Additionally, RYGB showed a higher rate of emergency room visits (11.4% vs. 7.4%, p<.001) and outpatient intravenous treatment (3.7% vs. 2.5%, p=.03) compared to SADI/BPD.

Conclusions

GERD and RWG are equally common indications for LSG conversion. In those with GERD, RYGB remains the primarily conversion option, but in those with RWG, BPD/SADI is utilized in over 20% of cases and appears to have an equal, if not better, 30-day safety profile.