ArticleSurgical endoscopy2026
Safety and feasibility of conversion of Roux-en-Y gastric bypass to BPD/DS versus SADI: an analysis of MBSAQIP database.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRecurrent weight gain (RWG) after Roux-en-Y gastric bypass (RYGB) is an increasingly common challenge. Biliopancreatic diversion with duodenal switch (BPD/DS) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) are surgical options available for achieving optimal clinical response in these patients.
objectivesThis study aimed to compare the characteristics and outcomes of patients who underwent either BPD/DS or SADI-S following RYGB.
methodsAn analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was conducted, focusing on patients from 2020 to 2022 who underwent BPD/DS or SADI-S following a primary RYGB. Postoperative bariatric outcomes, complication rates, and weight loss metrics-including percentage of excess weight loss (%EWL), total weight loss (%TWL), and excess BMI loss (%EBMIL) at 30 days-were evaluated. A stratified analysis was also performed to assess differences between the procedures.
resultsA total of 616 patients were included. 75.5% (n = 465) underwent BPD/DS and 24.5% (n = 151) SADI after RYGB. The majority of patients were female (90.7%, n = 559), with a mean age of 48.2 ± 9.1 years. The mean preoperative body mass index (BMI) was 47.5 ± 8.3 for patients undergoing BPD/DS and 44.5 ± 6.8 for those undergoing SADI (p < 0.001). Patients who underwent BPD/DS had a higher prevalence of hypertension (47% vs. 33.7%, p = 0.004) and ASA IV classification (12.2% vs. 1.3%, p < 0.001), but a lower rate of drain placement compared to those who underwent SADI (31.8% vs. 45%, p = 0.003). There was no statistically significant difference in terms of length of stay, operative time, or intraoperative/postoperative complications in the first 30 days. Weight loss outcomes at 30 days were comparable between the BPD/DS and SADI approaches.
conclusionsAmong patients undergoing conversion after RYGB, BPD/DS and SADI demonstrated comparable short-term bariatric outcomes, with similar 30-day postoperative complication rates.
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