Background

Bariatric surgery can cure obesity-related co-morbidities and improve patient quality of life. Weight plateau and regain following bariatric surgery remains a problem. Conversion to a more malabsorptive anatomy via a stomach intestinal pylorus-sparing surgery (SIPS) can improve weight loss.

Methods

A retrospective review of patients undergoing conversion to SIPS at a single center from 2017 to 2022 was performed. Patients were matched 2:1 based on pre-operative demographics and obesity-related co-morbidities with conversion from SG serving as the control group compared to conversion from RYGB. Patient parameters, operative characteristics, weight loss, and duration of follow-up were reported.

Results

A total of 36 patients were included; 24 with prior SG, and 12 with prior RYGB. Pre-operative BMI averaged 50.7 (range 41-70) in the SG group and 43.1 (32-57.6) in the RYGB group. Operative time was shorter in the SG group (49.9±9.4 minutes vs. 219.0±71.9 in RYGB group). There were no intra-operative complications. There were four post-operative complications; PO intolerance and hematoma in the RYGB group, dehydration and arrhythmia in the SG group. Follow-up was longer on average in the SG group (22.9 months vs. 11.3). Total body weight loss at 12 months post-conversion to SIPS was 32.9% in the SG group vs 19.8% in the RYGB group.

Conclusions

Conversion to SIPS from SG or RYGB is a safe approach to improve weight loss after index bariatric surgery. Greater weight loss can be expected after conversion from a purely restrictive procedure. Longer follow-up is necessary to determine the durability of weight loss after conversion to SIPS.