Laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass conversion versus primary Roux-en-Y gastric bypass: a propensity score matching analysis

BackgroundSecondary bariatric surgery rates have increased, accounting for approximately 19% of the total bariatric cases in the last years, most commonly conversion of sleeve gastrectomy to gastric bypass. Using the MBSAQIP, we evaluate the outcomes of this procedure compared to the primary RYGB surgery.MethodsThe new variable, conversion of sleeve gastrectomy to RYGB in the 2020 and 2021 MBSAQIP database was analyzed. Patients who underwent primary laparoscopic RYGB and those who underwent laparoscopic sleeve gastrectomy to RYGB conversion were identified. Using Propensity Score Matching analysis, the cohorts were matched for 21 preoperative characteristics. We then compared 30-day outcomes and bariatric-specific complications between primary RYGB and conversion from sleeve gastrectomy to RYGB.ResultsThere were 43,253 primary RYGB procedures performed and 6,833 conversions from sleeve gastrectomy to RYGB. The matched cohorts (n = 5912) for the two groups have similar pre-operative characteristics. Propensity-matched outcomes showed that conversion from sleeve gastrectomy to RYGB was associated with more readmissions (6.9% vs 5.0%, p < 0.001), interventions (2.6% vs 1.7%, p < 0.001), conversion to open (0.7% vs 0.2%, p < 0.001), length of stay (1.79 & PLUSMN; 1.77 days vs 1.62 & PLUSMN; 1.66 days, p < 0.001), and operative time (119.16 & PLUSMN; 56.82 min vs 138.27 & PLUSMN; 66.00, p < 0.001). There were no significant differences in mortality (0.1% vs 0.1%, p = 0.405), and bariatric-specific complications such as anastomotic leak (0.5% vs 0.4%, p = 0.585), intestinal obstruction (0.1% vs 0.2%, p = 0.808), internal hernia (0.2% vs 0.1%, p = 0.285) or anastomotic ulcer (0.3% vs 0.3%, p = 0.731) rates.ConclusionConversion from sleeve gastrectomy to RYGB is a safe and feasible operation with reasonable outcomes compared with primary RYGB.

Automated summary

Background: The rates of secondary bariatric surgery have increased, with sleeve gastrectomy to gastric bypass conversion being the most common. This study evaluates the outcomes of this conversion compared to primary Roux-en-Y gastric bypass (RYGB) surgery using MBSAQIP data. Methods: The study analyzed the data of patients who underwent sleeve gastrectomy to RYGB conversion and primary laparoscopic RYGB, matching them based on preoperative characteristics. Results: The analysis showed that the conversion from sleeve gastrectomy to RYGB was associated with higher readmissions, interventions, conversion to open surgery, longer hospital stay, and longer operative time compared to primary RYGB. However, there were no significant differences in mortality or rates of bariatric complications. Conclusion: The study concludes that conversion from sleeve gastrectomy to RYGB is a safe and feasible procedure with reasonable outcomes compared to primary RYGB.