Background

Laparoscopic sleeve gastrectomy (SG) is the most frequent bariatric surgery globally. Although most patients achieve adequate weight loss and comorbidity improvement, a subset seek conversion to another procedure.

Methods

A retrospective chart review of all SG patients examined the frequency and characteristics of SG patients returning for conversion to laparoscopic Roux-en-Y gastric bypass (LR) for weight regain versus medical conditions.

Results

From 2006 through March 2021, 99 of 2186 SG patients (4.5%) initiated the preparation process for conversion to LR. Patients seeking conversions were significantly younger (40.1 vs 44.9 years) and more likely to be female (87.9 versus 77.5%) than those satisfied with SG. Sixty-nine patients obtained a LR and 4 remain in the preparation process. The primary indication for surgery was a medical condition in 63 patients (61 related to GERD, and 1 each for intractable vomiting/malnutrition and gastric perforation/abscess) and weight-related concerns in 6 patients. Weight and BMI pre-conversion were 242.5 lb and 39.3 kg/m2 and 197.9 lb and 32.2 kg/m2 1 year post-conversion. Weight loss and complications did not differ by indication for surgery. Of 26 patients initiating but not achieving conversions, the most common reason was failure to initiate or complete required medically supervised weight loss (19/26 noncompleters).

Conclusions

A small percentage of SG patients inquire about conversion to LR. Most patients initiating the conversion process had medical concerns, primarily worsening GERD. While most patients inquiring about conversion completed the process, the required 6-month medically supervised weight loss was a barrier for 19% of patients.