Recurrent Weight Gain after Sleeve Gastrectomy: Is Conversion to Duodenal Switch Superior to Roux-en-Y Gastric Bypass?

Background: Rates of conversion procedures after Sleeve Gastrectomy have been reported to reach up to 12.2% in 10 years of follow-up. The aim of this study was to compare perioperative outcomes and weight changes in patients who underwent either conversion from SG to Roux-en-Y Gastric Bypass (C-RYGB) or Duodenal Switch (C-DS).

Methods: This study was a nonrandomized, controlled, retrospective review of 100 patients who underwent conversion of LSG due to recurrent weight gain at our institution from May 2015 to November 2024. Perioperative and postoperative variables were examined.

Results: Of 481 SGs, 100 patients (90 C-RYGB; 10 C-DS) underwent conversion due to recurrent weight gain. The C-DS group had a higher preoperative BMI compared to C-RYGB (57.2 kg/m² vs 38.9 kg/m², p < 0.001). Additionally, C-DS showed shorter operative time (142.5 min vs 193.8 min, p = 0.02) and similar length of hospitalization than C-RYGB. There was no significant difference in late reoperation rate between groups (13 [14.4%] C-RYGB vs 2 [20%] C-DS). The C-DS group had significant differences in %TWL at 6-,12- and 24-month follow-up with values of 21% vs 15.5%, 30% vs 18.2% and 33% vs 19% over C-RYGB, respectively. Excess preoperative BMI at the time of conversion was associated with a greater weight loss (each 1 kg/m² increase yielded 0.7% greater %TWL). However, no significant correlation was found between these two variables (p = 0.24, R² = 0.05).

Conclusions: C-DS appears to be safe and feasible for the surgical management of recurrent weight gain after LSG. In addition, C-DS provides a significantly higher %TWL on 6, 12 and 24 months compared to C-RYGB.