Revisional Options after Roux-en-Y Gastric Bypass: A MBSAQIP Analysis of Biliopancreatic Diversion with Duodenal Switch Versus Limb Lengthening.

BACKGROUND: Recurrent weight gain after Roux-en-Y gastric bypass (RYGB) has become increasingly common. This study aimed to compare short-term surgical outcomes between patients undergoing Limb Lengthening (LL) versus Biliopancreatic Diversion with Duodenal Switch (BPD/D) after RYGB. METHODS: A retrospective analysis of the MBSAQIP database (2020-2023) was performed, including patients that underwent revisional surgery with LL or BPD/DS following RYGB. Thirty-day postoperative outcomes including overall postoperative complications (OPC) and unplanned health care utilization (UHCU), were analyzed. A multivariable logistic regression analysis and subgroup analysis were used to assessed for Bias. RESULTS: A total of 1456 patients were included: 58.8% (n = 857) underwent LL and 41.1% (n = 599) BPD/DS. Female patients (88.0%, n = 1,282), mean age of 49.5 ± 9.4 years. Patients undergoing BPD/DS had higher BMI (47.3 versus 42 kg/m2), ASA class III-V (91.1% versus 80.7%), drain placement (31.7% versus 9.2%), and robotic approach (40.2% versus 18.7%), longer procedure time (212.2 versus 119.5 minutes), hospital length of stay (2.9 versus 1.5 days), (all P < .001). BPD/DS patients had higher OPC (15.2% versus 4.9%), including higher leaks, surgical site infections, and ICU admission, adjusted OR = 3.22 (95% CI = 1.81-5.72); they also had higher UHCU (27.2% versus 14.5%). On multivariate analysis, besides BPD/DS revision, BMI > 50, history of pulmonary embolism, and drain placement were identified as independent risk factors for OPC. CONCLUSIONS: Compared with RYGB-LL, patients undergoing RYGB-BPD/DS had longer operative time, hospital stay, and OPC. BPD/DS as a conversion technique, BMI > 50, history of pulmonary embolism, and drain placement were identified as independent risk factor for OPC.