Background

Patients experiencing weight regain after sleeve gastrectomy often undergo conversion to Roux-en-Y gastric bypass (RYGB). Alternatively, re-sleeve gastrectomy is considered, alongside options like duodenal switch or one-anastomosis gastric bypass. No consensus exists on which technique is the best. We aim to compare short terms outcomes between re-sleeve and conversion to RYGB.

Methods

Laparoscopic re-sleeve gastrectomy and conversion from sleeve to RYGB for weight regain or inadequate weight loss were identified in the MBSAQIP database (2020- 2021). Propensity score matching considering variables like age, sex, BMI, diabetes, smoking, steroid use, and ASA class, was performed. The primary outcome was reoperation rate at 30 days.

Results

In 2020-2021, 6,797 patients underwent laparoscopic re-sleeve gastrectomy (n=1,063) or conversion to RYGB (n=5,734). After 1:1 matching (1,061 cases/group), re-sleeve had lower incidence of hypertension (30.5% vs 37.5%, p=0.001). Reoperation rate at 30 days did not differ between both procedures (1.8% vs 2.7%, p=0.144) and there were no significant differences in readmission (6% vs 6.4%, p=0.719), reintervention (2.7% vs 1.7%, p=0.105) and postoperative mortality (0.1% vs 0.1%, p=1). Postoperative complications were similar, except for a higher anastomosis/staple line leak rate after re-sleeve gastrectomy (1.3% vs 0.5%, p=0.038) and increased bowel obstruction after conversion to RYGB (0.2% vs 1.2%, p=0.007).

Conclusions

Both procedures are safe for patients with weight regain following sleeve gastrectomy. It is important to consider the increased risk of leaks associated with re-sleeve gastrectomy while deciding on this procedure. Long-term data on weight-loss and GERD are missing for determining the most appropriate procedure.