Conversion metabolic bariatric surgery after sleeve gastrectomy: an MBSAQIP analysis

BACKGROUND: Conversion Metabolic Bariatric Surgery (cMBS) is increasingly common despite the effectiveness of primary bariatric surgery for obesity and the medical conditions associated with obesity. OBJECTIVES: This study used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, a retrospective national database, to analyze trends in cMBS following sleeve gastrectomy and compare postoperative outcomes among different types of conversions. SETTING: American College of Surgeons MBSAQIP Centers of Excellence across the United States. METHODS: A retrospective analysis of the 2020-2021 MBSAQIP database was performed, inclusive of patients who underwent cMBS from sleeve gastrectomy to biliopancreatic diversion with duodenal switch (BPD/DS), Roux-en-Y gastric bypass (RYGB), Roux-en-Y distal gastric bypass (RYGB-d), single-anastomosis duodeno-ileal bypass sleeve (SADI-s), and one-anastomosis gastric bypass (OAGB). Descriptive analyses and multivariable logistic regression models were performed to analyze 30-day outcomes. RESULTS: Out of 18,179 conversions from sleeve gastrectomy, 1,153 (6.3%) were to BPD/DS, 15,425 (85%) to RYGB, 685 (3.7%) to RYGB-d, 723 (3.9%) to SADI-s, and 193 (1.1%) to OAGB. Common indications included gastroesophageal reflux disease (GERD) and inadequate weight loss or weight gain. Minor complications were significantly lower (p = 0.012) for cMBS to BPD/DS and SADI-s (1.4-1.5%), compared with RYGB, RYGB-d, and OAGB (2.5-2.8%), with no statistically significant differences in major complications (p = 0.41). Readmission rates were higher for cMBS to RYGB, RYGB-d, and OAGB (19-20%), compared to BPD/DS and SADI-s (14-15%) (p < 0.001). CONCLUSIONS: cMBS are increasingly needed due to GERD or suboptimal weight outcomes. While major complications appear comparable across conversion types, RYGB, RYGB-d, OAGB have higher rates of readmissions and minor complications.