Background

Patients undergoing sleeve gastrectomy (SG) may undergo conversion to Roux-en-Y gastric bypass (RYGB) for gastroesophageal reflux (GERD) or unsatisfactory weight loss. However, characteristics and predictors among patients requiring conversion surgery are unclear.

Methods

Data from the Michigan Bariatric Surgery Collaborative registry was used to identify all patients who underwent SG from 2006-2022 (n=67,476) with subsequent conversion to RYGB (n=971). Multivariable stepwise logistic regression was performed to identify risk factors predictive for SG to RYGB conversion. Postoperative outcomes were compared between patients who underwent RYGB conversion and a propensity score-matched cohort of patients undergoing primary RYGB

Results

Conversion patients had a mean age of 42.7 years, 91.1% were female, mean body mass index was 48.4 kg/m2 and 60.4% were diagnosed with GERD at the time of SG. Concurrent hiatal hernia repair occurred in 33.7% of cases, and mean total body weight loss at 1 year was 27.8%. Mean time from primary SG to RYGB conversion was 3.5 years. Independent predictors of patients undergoing SG to RYGB conversion include GERD and asthma (Figure). SG to RYGB cases had higher rates of surgical complications (12.1% vs. 7%, p = 0.02) with less total body weight loss (27.6%, vs. 33.6%, p <0.001) and similar GERD outcomes when compared to matched primary RYGB cases alone.

Conclusions

Patients and providers should be informed of factors that may increase the need for revisional surgery after SG. Conversion to RYGB incurs more risk and less weight loss than undergoing a primary RYGB.