Long-Term Outcomes up to 10 Years After Indication-Based Conversion to One-Anastomosis Gastric Bypass or Roux-En-Y Gastric Bypass Following Sleeve Gastrectomy.

INTRODUCTION: Sleeve gastrectomy (SG) is the most performed bariatric surgery worldwide. Over time, conversion may be required for refractory weight recurrence (WR), gastroesophageal reflux disease (GERD), or both. This study evaluated indication-based conversion outcomes after SG. METHODS: At a single center, 576 SG procedures were performed between 2007 and 2019. Procedure selection was predefined: one-anastomosis gastric bypass (OAGB) for WR without GERD, and Roux-en-Y gastric bypass (RYGB) for GERD with or without WR. Follow-up included weight measurements and upper gastrointestinal endoscopy at 1, 5, and 10 years. Ten-year analyses were restricted to patients converted between 2007 and 2014. Weight-loss analyses excluded isolated GERD conversions. RESULTS: Follow-up after primary SG was available in 423/576 patients at 1 year and 283/576 at 5 years. Among patients with 5-year follow-up, 87/283 underwent conversion: 43 to RYGB and 44 to OAGB. Mean total weight loss (TWL) after RYGB was 31.2%, 23.5%, and 21.6% at 1, 5, and 10 years; after OAGB, it was 32.8%, 29.9%, and 27.4%. At 10 years, TWL data were available for 4 RYGB and 18 OAGB patients. GERD with esophagitis after conversion was observed after RYGB in 2/43, 1/41, and 1/9 patients at 1, 5, and 10 years, and after OAGB in 0/43, 0/42, and 0/18. CONCLUSION: In this indication-based cohort, OAGB showed sustained TWL after conversion for WR without GERD, whereas RYGB provided reflux control in most GERD conversions. Between-procedure differences were descriptive, reflecting non-randomized allocation and small 10-year denominators.