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Secondary Bariatric Surgery—Does the Type of Index Procedure Affect Outcomes After Conversion?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Although revisions account for 17% of cases performed at bariatric centers of excellence, scarce data exists on whether index operation type influences outcomes after secondary operations.

Objective

We designed a study investigating the effect of primary procedure type on weight loss and perioperative complications after conversion bariatric surgery.

Setting

Tertiary Referral Hospital, USA.

Methods

We performed a retrospective review of patients undergoing conversion from sleeve gastrectomy (SG) or adjustable gastric band (AGB) to Roux-en-Y gastric bypass (RYGB) from 2009 to 2019. Post-operatively, we measured short- and medium-term complications and changes in body weight at various time points. Univariate and regression analyses were performed.

Results

Forty-two (SG) patients and 116 (AGB) patients underwent conversion to RYGB, most commonly for GERD (57.1%) in SG patients vs. weight regain (77.6%) in AGB patients. Mean pre-conversion BMI was 36.7 kg/m2 (SG) vs 43.8 kg/m2 (AGB). Mean time to conversion (months) was 52.9 (SG) vs 94.7 (AGB). Complication rate was 9.5% (SG) vs 6% (AGB) at 30 days (p = 0.48) and 31%(SG) vs 14.5% (AGB) (p = 0.02) at 2 years. Mean post conversion %TWL was 11.6% (SG) vs 24.6% (AGB) in patients with GERD/dysphagia (p = 0.014) and 20.7% (SG) vs 27.6% (AGB) in patients converted for weight-related reasons (p = 0.027) at 1 year. Overall mean %TWL was 13.2% (SG) vs 24.7% (AGB) at 2 years (p < 0.0035).

Conclusion

After conversion to RYGB, patients with AGB experience better short- and medium-term weight loss than those with SG, even after accounting for conversion indications. SG to RYGB conversions have a higher resolution of reflux disease.

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Abbreviations

AGB:

Adjustable gastric band

SG:

Sleeve gastrectomy

RYGB:

Roux-en-Y gastric bypass

GERD:

Gastroesophageal reflux disease

IWL:

Inadequate weight loss

WR:

Weight regain

BMI:

Body mass index

CD:

Clavien-Dindo

COE:

Center of Excellence

MBSAQIP:

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project

%TWL:

Percentage of total body weight loss

ASA:

American Society of Anesthesiology

ASMBS:

American society of Metabolic and Bariatric Surgery

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Author information

Authors and Affiliations

  1. Department of Surgery, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA, 30308, USA

    Omobolanle Oyefule

  2. Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Omobolanle Oyefule, Timothy Do, Raveena Karthikayen, Ray Portela, Travis McKenzie, Todd Kellogg & Omar M. Ghanem

  3. Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Barham Abu Dayyeh

Authors
  1. Omobolanle Oyefule
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Correspondence to Omar M. Ghanem.

Ethics declarations

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this was a retrospective study, for this type of study, formal consent is not required.

Conflict of Interest

Barham Abu Dayyeh disclosure: Consulting for Endogenex, Endo-TAGSS, Metamodix, and BFKW; consultant and grant/research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; Speaker roles with Olympus, Johnson and Johnson; speaker and grant/research support from Medtronic, Endogastric solutions; and research support from Apollo Endosurgery, and Spatz Medical. The other authors declare that they have no conflict of interest, financial, or other relationship disclosures to make related to the work in this manuscript. This manuscript has been read and approved by all authors listed herein.

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Oyefule, O., Do, T., Karthikayen, R. et al. Secondary Bariatric Surgery—Does the Type of Index Procedure Affect Outcomes After Conversion?. J Gastrointest Surg 26, 1830–1837 (2022). https://doi.org/10.1007/s11605-022-05385-y

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  • DOI: https://doi.org/10.1007/s11605-022-05385-y

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