Background

Patients are increasingly experiencing weight regain or insufficient weight loss after primary Roux-en-Y Gastric Bypass (RYGB) procedures. The use of a conversion to Biliopancreatic Diversion with Duodenal Switch (BPD/DS) or Single Anastomosis Duodeno-Ileal bypass (SADI) remains a rare occurrence in practice and literature. Therefore, our primary aim was to compare outcomes between patients receiving a conversion from RYGB to either BPD/DS or SADI.

Methods

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was used for years 2020-2021. Propensity score matching was conducted in a 1:1 nearest neighbor fashion with a 0.2 caliper width to create two well-balanced cohorts.

Results

A total of 349 patients were available for analysis, with 277 patients undergoing conversion from RYGB to BPD/DS and 72 patients converted from RYGB to SADI. A total of 331 patients had a conversion due to either inadequate weight loss (n=165) or weight regain (n=166). Before matching, patients receiving the conversion to BPD/DS experienced significantly increased rates of preoperative hypertension (48.4% vs 31.9%,p=0.018) and sleep apnea (37.5% vs 18.1%,p=0.003). Propensity score matching (PSM) yielded 68 patient pairs with adequate covariation between groups. Four SADI patients did not match due to inadequate control availability. After matching, there were no statistically significant differences in postoperative outcomes. Additionally, operative time was similar between both groups (209.3 min +- 74 vs 213.8 min +- 95,p=0.745).

Conclusions

The postoperative outcomes between conversion from RYGB to either BPD/DS or SADI have shown to be similar after propensity score matching.