From the Research
Conversion of bariatric surgery to another procedure is necessary in cases of inadequate weight loss, weight regain, severe complications, or anatomical failures of the primary procedure, with the most common indications being gastroesophageal reflux disease (GERD) and weight loss failure (WLF) 1. The decision to convert should be made after thorough evaluation of the patient's anatomy, nutritional status, comorbidities, and psychological factors.
- Indications for conversion include:
- Persistent severe reflux disease after sleeve gastrectomy
- Chronic malnutrition or excessive weight loss following Roux-en-Y gastric bypass
- Inadequate weight loss (defined as <50% excess weight loss at 18-24 months post-surgery)
- Significant weight regain (regaining >50% of lost weight)
- Intractable marginal ulcers
- Chronic abdominal pain
- Persistent hypoglycemia
- Severe dumping syndrome unresponsive to medical management
- Technical complications warranting conversion include:
- Gastric band erosion, slippage, or port-related issues
- Sleeve stenosis or severe dilation
- Anastomotic complications like leaks or strictures
- Internal hernias causing recurrent small bowel obstructions The most frequent conversions are from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) for GERD and WLF, and from adjustable gastric banding (AGB) to SG or RYGB for WLF 1. Conversion procedures carry higher risks than primary operations due to altered anatomy, adhesions, and potentially compromised tissue quality, with postoperative overall morbidity, serious morbidity, reoperation, and mortality rates ranging from 5.3 to 20.8%, 2.3 to 19.2%, 1.5 to 10%, and 0 to 0.8%, respectively 1. Patients should undergo comprehensive nutritional assessment and optimization before conversion surgery, and post-conversion management requires close monitoring of nutritional parameters and potential complications. According to the most recent study, the most common conversions are SG to RYGB, with a higher resolution of reflux disease, and AGB to SG or RYGB, with better short- and medium-term weight loss outcomes 2.