Background

Weight recidivism after RYGB can be seen in approximately 25% of patients. Surgical management options include revision of RYGB and conversion to DS/SADI. Using recentlyincluded revision surgery variables in the MBSAQIP database we compared the safety andefficacy of RYGB revision with conversion to DS/SADI.

Methods

An analysis of the 2020 MBSAQUIP PUF revealed 1421 patients who underwent revision ofRYGB (n=1255) or conversion from RYGB to DS/SADI (n=166) for inadequate weight loss orweight regain. Patient characteristics, preop BMI, OR time, 30 day complications and weightloss was compared between groups.

Results

When compared with the revision RYGB group, the DS/SADI conversion group had highermean BMI (47.50 vs 42.73, p<0.001) and longer operative time (209.05 vs 133.35 min,p<0.001). DS/SADI had higher rates of any complication compared to revision RYGB (22.3 vs5.6%, p<0.001), including higher 30 day readmission rates (16.27 vs 5.5%, p<0.001),reoperation within 30 days (9.0 vs 2.9%, p<0.001), VTE (3.01 vs 0.08%, p<0.001), ICU admission(8.4 vs 0.7%, p<0.001) anastomotic leak (7.8 vs 0.4%, p<0.001), SSI (11.25 vs 2.63%, p<0.001)and death (0.6 vs 0.0%, p<0.001). The DS/SADI group had more weight loss at 30 days (46.65vs 29.21lbs, p=0.0045).

Conclusions

These data suggest that conversion of RYGB to DS/SADI is associated with significantly higherrates of postoperative complications when compared with revision RYGB and should beconsidered when counseling patients on surgical options for weight recidivism after RYGB.