Five-Year Outcomes of Robotic Revisional Surgery for Insufficient Weight Loss and Weight Regain After Sleeve Gastrectomy

Background Sleeve gastrectomy (SG) is the most performed bariatric procedure worldwide, yet the reported rate of surgical conversions due to insufficient weight loss (IWL) or weight regain (WR) is 10-20%. Aims The aim of this study was to determine the best metabolic response after robotic SG conversions for IWL/WR and identify the most appropriate surgical option. Methods We analysed prospective registry data from eight expert centres across three continents. Included patients underwent either secondary robotic Roux-en-Y gastric bypass (rRYGB) or robotic biliopancreatic diversion with duodenal switch (rBPD-DS) for IWL/WR after SG. Perioperative outcomes, postoperative morbidity assessed using the Comprehensive Complication Index (CCI®), total bodyweight loss (TBWL), and SFBARI scores were compared at 90 days, 1 year and 5 years. Results 148 patients were included; 79·7% were females, with a mean (SD) age of 44·0 (10·1) years and baseline BMI of 45·2 (8·4) kg/m². 55 (37·2%) underwent rRYGB and 93 (62·8%) rBPD-DS. Baseline characteristics were comparable. Median hospital stay was 2 days in both groups (p=0·84). An uneventful 90-day postoperative course occurred in 92·7% of patients undergoing rRYGB and 82·8% undergoing rBPD-DS (p=0·088). At 1 year, follow-up was available for 79·1% of patients; TBWL did not differ between groups (17·7% for rRYGB vs 19·2% for rBPD-DS; p=0·36), nor did SFBARI scores (33·9 vs 36·1; p=0·52). At 5 years, follow-up was available for 53·4% of patients; rBPD-DS was associated with greater TBWL (25·3% vs 14·1%; p=0·003) and higher SFBARI scores (45·1 vs 24·6; p=0·006). Conclusion As a secondary procedure for IWL/WR after SG, rBPD–DS was associated with a 9.9% higher 90-day morbidity compared to rRYGB. At 5-year follow-up, rBPD–DS was associated with significantly greater weight loss and higher SFBARI scores, suggesting a potential long-term advantage over rRYGB.