Safety and Feasibility of Sleeve Gastrectomy Conversion to Roux-en-Y Gastric Bypass Versus Single Anastomosis Duodeno-Ileal Bypass: An MBSAQIP Analysis

Background: Sleeve gastrectomy (SG) has become the most common bariatric procedure worldwide. Unfortunately, a significant number of patients require conversion to Roux-en-Y gastric bypass (RYGB) or single-anastomosis duodeno-ileal bypass (SADI) because of recurrent weight gain. This study aimed to determine the rates of complications and mortality associated with conversion from SG to RYGB (SG-RYGB) compared with conversion from SG to SADI (SG-SADI). Methods: This retrospective analysis used data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2020 to 2022. Patients undergoing SG-RYGB or SG-SADI were included. Thirty-day operative outcomes, intraoperative and postoperative events, and mortality were analyzed. Results: A total of 28,758 patients were included. Of these, 27,412 (95.3%) underwent SG-RYGB and 1346 (4.6%) underwent SG-SADI. The mean preoperative body mass index was 39.7 kg/m 2 for SG-RYGB and 45.3 kg/m 2 for SG-SADI ( P < .001). SG-RYGB was associated with a higher frequency of intraoperative/postoperative complications within the first 30 days (5.9% versus 3.4%, P < .001), including transfusion (1.3% versus 0.4%, P = .004), readmission (7.3% versus 4.6%, P < .001), and emergency department visits (12.5% versus 8.5%, P < .001). Although SG-SADI was associated with a higher rate of anastomotic leak (0.4% versus 1.1%, P < .001), there was no difference in reoperation rates (2.8% versus 2.5%) or deaths (0.02% versus 0%). Overall, SG-SADI-S was associated with a lower risk of intraoperative/postoperative complications, with an adjusted odds ratio of 0.741 (95% confidence interval: 0.543–0.901, P = .041). Conclusions: Both revisional procedures are safe. Although SG-RYGB was associated with a higher frequency of intraoperative/postoperative complications within the first 30 days, SG-SADI had a higher rate of anastomotic leaks, with no difference in reoperation rates or deaths.