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OUTCOMES AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY CONVERSION TO ROUX-EN-Y GASTRIC BYPASS AND SINGLE ANASTOMOSIS DUODENAL SWITCH
Jean-Christophe Rwigema
*, Derrius Anderson, Sullivan A. Ayuso, Kristine Kuchta, Natalie Liu, takagi taisuke, Ervin Denham, John Linn, H. Mason Hedberg, Michael Ujiki
NorthShore University HealthSystem, Evanston, IL
Background:
Sleeve gastrectomy (SG) is the most common bariatric procedure, accounting for approximately 70% of all primary bariatric procedures in the United States. As revisional surgery becomes more prevalent, there is greater need to clarify expected outcomes. This study aims to examine and compare outcomes between SG conversion to Roux-En-Y Gastric Bypass (RYGB) and Single Anastomosis Duodenal Switch (SADI-S).
Methods:
A retrospective review of a prospectively maintained bariatric database was performed for all patients undergoing revisional surgery after SG to RYGB and SADI-S. Demographic data, perioperative, and postoperative outcomes were included. A subgroup analysis with only patients with weight recurrence was also performed. Descriptive statistics were used for analysis and outcomes were compared using the chi-square test.
Results:
From 2017-2024, 44 patients underwent either laparoscopic RYGB or SADI-S after SG. Indications were weight recurrence (N=25), GERD (N=13), stricture (N=3), leak (N=1), and GERD and weight recurrence (N=2). There were no significant differences in patient demographics between the RYGB and SADI-S groups. Mean time from SG to revision was 58 months. Initial mean BMI prior to conversion for all patients was 43.7±8.8 kg/m
2. Mean change in BMI at 1 year postoperatively was 6.1±9.8 kg/m
2 (p= 0.01). Percent excess weight loss (%EWL) at 2 years postoperatively was 45.6±31.3(p< 0.0001). Percent EWL for RYGB and SADI-S at 6 months, 1 year, and 2 years postoperatively were (47.1±22.5 vs 41.8±38.4; p= 0.2), (73.6±43.3 vs 46.9±25.8; p= 0.4), and (49.8±21.6 vs 38.4±21.7; p= 0.6), respectively. There were no intraoperative complications. The overall complication rate was 22.7%. There were no significant differences in postoperative complication, postoperative intervention, and readmission rates. There were no mortalities in either group.
Conclusion:
In this series evaluating revision after SG, RYGB and SADI-S produce sustained and statistically equivalent weight loss up to 2 years. Our overall complication rate compares to previously reported rates after revisional surgery. Both RYGB and SADI-S are safe and effective revisional options after SG.
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