BPD/DS and SADI-S show comparable short-term outcomes as revisional procedures following RYGB

Both biliopancreatic diversion with duodenal switch (BPD/DS) or single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) show comparable short-term outcomes when performed as revisional procedures following RYGB. Although overall perioperative complications did not differ between groups, the approximately 6% anastomotic leak rate observed in both cohorts highlights the greater complexity and risk inherent to revisional bariatric surgery relative to primary operations, according to the study’s authors from Montefiore Medical Center, New York, NY.

Most data in the literature compare both techniques as a revisional procedure after SG, but not after RYGB, the researchers noted. Understanding these outcomes is critical to guiding surgical decision-making, patient counselling and assessing the perioperative risks.

Their study sought to analyse and compare the perioperative characteristics, complication rates, and short-term weight loss outcomes of patients undergoing conversion from RYGB to either BPD/DS or SADI-S. Using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, a total of 616 patients who underwent either BPD/DS or SADI-S following a primary RYGB between 2020 and 2022 were included in the analysis. Of these, 465 patients (75.5%) underwent conversion to BPD/DS, while 151 patients (24.5%) underwent conversion to SADI-S.

The primary outcomes included 30-day postoperative complications. The following variables we included: surgical site infection (SSI), anastomotic leak, wound dehiscence, pneumonia, pulmonary embolism (PE), acute kidney injury (AKI), myocardial infarction (MI), sepsis, gastrointestinal bleeding, death, reoperations, readmissions, and emergency department visits within 30 days.

The secondary outcomes of the study included: operative variables such as surgical approach (open, laparoscopic, robotic), operative time, conversion to open, and drain placement. Additionally, weight loss outcomes expressed as percent excess weight loss (%EWL), total weight loss (%TWL), and excess BMI loss (%EBMIL) at 30 days postoperatively were evaluated.

Outcomes

The majority of patients were female (90.7%), with a mean age of 48.2 ± 9.1 years. The mean preoperative BMI was 47.5 ± 8.3 for patients undergoing BPD/DS and 44.5 ± 6.8 for those undergoing SADI (p<0.001). The prevalence of hypertension (47% vs. 33.7%, p = 0.004) and ASA class IV status (12.2% vs. 1.3%, p<0.001) was also higher in the BPD/DS group. There were no statistically significant differences in age, diabetes mellitus, hyperlipidaemia, GERD, smoking status or most other comorbidities.

They found that there were no significant differences between the two groups in terms of operative time (211.6 ± 82.9 min vs. 211.9 ± 86.9 min, p=0.429) or hospital length of stay (3.0 ± 4.6 vs. 3.1 ± 4.1 days, p=0.747). However, patients in the SADI-S group had higher rates of drain placement (45% vs. 31.8%, p=0.003). The majority of surgeries in both groups were performed laparoscopically or robotically, with no statistically significant differences in surgical approach or conversion rates.

The overall 30-day complication rate was similar between the two groups (17.2% in BPD/DS vs. 18.5% in SADI-S, p=0.706). Anastomotic leaks were reported in 5.8% of BPD/DS and 5.9% of SADI-S patients (p=0.944). Gastrointestinal bleeding occurred in 3.0% of BPD/DS versus 1.3% of SADI-S patients (p=0.388), while intraoperative or postoperative transfusion requirements were 3.8% and 2.6%, respectively (p=0.482). Rates of other complications (surgical site infections, anastomotic leak, pneumonia, pulmonary embolism, acute kidney injury, and sepsis) were also not significantly different. There were 4 reported deaths (0.6%), all occurring in the BPD/DS group (p=0.252).

Rates of reoperation (7.9% vs. 7.2%, p=0.788), readmission (14.8% vs. 13.9%, p=0.778), and emergency department visits (12% vs. 11.2%, p=0.795) within 30 days were comparable between the two groups.

The researchers also reported weight loss outcomes at 30 days were comparable between the BPD/DS and SADI-S approaches. The mean percentage of excess weight loss (%EWL) was 11.4 ± 9.7% in the BPD/DS group versus 14.4 ± 7.8% in the SADI-S group (p=0.462). Total weight loss (%TWL) was 6.0 ± 5.1% for BPD/DS and 7.1 ± 3.6% for SADI-S (p=0.323). Similarly, percentage excess BMI loss (%EBMIL) was 12.9 ± 11.7% in BPD/DS patients compared to 16.3 ± 9.5% in those who underwent SADI-S (p = 0.531). None of the differences reached statistical significance, indicating that both procedures achieved similar early weight loss effectiveness.

“Careful patient selection, meticulous operative technique, and heightened postoperative vigilance are therefore essential when considering these procedures,” the authors cautioned. “Further studies with long-term follow-up are needed to evaluate sustained weight loss, nutritional consequences, and quality of life outcomes.”

The findings were featured in the paper, ‘Safety and feasibility of conversion of Roux-en-Y gastric bypass to BPD/DS versus SADI: an analysis of MBSAQIP database’, published in Surgical Endoscopy. To access this paper, please click here