Conversion of sleeve gastrectomy to different types of bipartitions: OATB, B-TB, and RYTB-a retrospective single-center study.

Introduction: As the prevalence of sleeve gastrectomy (SG) continues to rise each year, so does the number of patients requiring conversion to a hypoabsorptive procedure due to suboptimal results. While various types of bypass surgeries have been studied, available literature on transit bipartitions (TB) remains limited.

Methods: We conducted a retrospective analysis of patients who underwent conversion of SG to TB at our institution between November 1, 2017 and March 30, 2022. Three TB techniques were evaluated: one anastomosis sleeve-ileal TB (OATB), sleeve-ileal loop TB with Braun jejunoileostomy (B-TB), and TB with a Roux-en-Y formed small bowel short circuit (RYTB). Additional percentage of excess weight loss (%EWLadditional), percentage of total body weight loss (%TWL), and resolution of obesity-related comorbidities were the primary outcomes, while adverse effects were analyzed to assess the safety of each procedure.

Results: Of the 482 SG-to-TB conversions performed by March 2024, 171 patients with a complete follow-up (FU) of 2 years were included and matched by sex, age, and Body Mass Index (BMI) at the time of conversion. The %EWLadditional for OATB, B-TB, and RYTB at 2 years FU was 50.1, 53.4 and 54.3, respectively, with no significant differences in weight loss outcomes over time. OATB patients experienced more long-term adverse effects and showed a higher rate of reoperation.

Conclusiuon: TB after SG is a feasible and effective revisional procedure for achieving further weight loss and managing obesity-realated comorbidities. OATB, however, may be associated with a higher risk of long-term complications compared to other TB techniques.