Background

Conversion bariatric surgery for inadequate weight loss or weight gain remains controversial. Sleeve gastrectomy is most commonly converted to Roux-en-Y gastric bypass (RNYGB). However, conversion to single anastomosis duodeno-ileal bypass (SADI) has become increasingly popular. This study compares the safety of sleeve gastrectomy conversion to RNYGB versus SADI.

Methods

The 2020 MBSAQIP database was queried for patients who underwent conversion from sleeve gastrectomy to RNYGB or SADI. Only patients who underwent conversion for inadequate weight loss or weight gain were included. Multivariable regression analyses examined the association of conversion surgery choice on clinical outcomes.

Results

Overall 2,385 patients were included; 2,114 patients underwent conversion to RNYGB while 271 underwent conversion to SADI. The median age was 44, and the median body mass index was 42. There were 311 (13%) male patients. Multivariable linear regression showed that SADI was significantly associated with longer operative times (regression coefficient 12.266, p=0.007). Multivariable logistic regression showed that SADI was significantly associated with higher rates of postoperative leak compared to RNYGB (odds ratio [OR] 3.835, p=0.019). Compared to RNYGB, SADI was not significantly associated with higher rates of bleeding (OR 0.753, p=0.648) or 30-day bowel obstruction (OR 0.734, p=0.561). No significant difference in postoperative intervention (OR 1.050, p=0.909) or reoperation (OR 1.761, p=0.136) was observed.

Conclusions

Compared to RNYGB, conversion from sleeve gastrectomy to SADI was significantly associated with higher leak rates but neither readmission nor reoperation. Additional research is required to determine whether increased familiarity with SADI conversion can improve its outcomes.