Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for weight recurrence and functional complications: a single-center experience.

BACKGROUND

Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Despite its effectiveness, SG may lead to weight regain, gastroesophageal reflux disease (GERD), or functional complications such as strictures, prompting conversion to Roux-en-Y gastric bypass (RYGB).

OBJECTIVES

To report the indications for conversion from SG to RYGB and analyse their postoperative outcomes, including complications and weight loss when stratified by indication.

SETTING

Single academic, bariatric center in the United States.

METHODS

We conducted a retrospective analysis of all SG-to-RYGB conversions between 2004 and 2022. Patients were divided between Group A (converted for GERD or stricture) and Group B (weight regain). We compared demographics, complications, length of stay, and weight-related outcomes, including a subgroup analysis of patients converted for GERD and strictures.

RESULTS

A total of 134 patients were included. From these, 50.7% were converted for weight regain 38.8% for GERD, and 10.4% for strictures. Mean time to conversion was 57.7 months (40.5 months for Group A; 64.1 for Group B). Major complications occurred in 5.2% of cases, with 7.6% in Group A and 2.9% in group B. Stricture patients had a higher complication rate when compared to GERD (53.8% vs 9.4%). In Group B, mean body mass index decreased from 43.4 to 32.1 at 12 months (p < 0.01), with sustained percent excess body mass index loss above 48% at >48 months.

CONCLUSIONS

Conversion of SG-to-RYGB is safe and effective to achieve durable weight loss. However, patients converted for strictures face significantly higher risks and require tailored perioperative strategies.