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Despite the fact Roux-en-Y gastric bypass (RYGB) is one of the most efficient bariatric procedures, postoperative weight regain still can be seen. To retrospectively assess the early outcomes and up to 10-year weight results of the conversion of RYGB to biliopancreatic diversion with duodenal switch (BPD-DS). French private hospital, 2-surgeon practice in a bariatric surgery center with an experience of >20 RYGB procedures. Analysis was conducted on patients who had a conversion of RYGB to BPD-DS performed since 2010 for a percentage of excess weight loss (%EWL) <50% with a small gastric pouch. A total of 65 females and 9 males aged 46.8 ± 8.8 years had an RYGB procedure done 110.6 ± 38.8 months earlier for a body mass index of 47.4 ± 7.8 kg/m2. Conversion was always performed in 1 stage and laparoscopically for 93% of the patients. The 30-day complication rate was 25.7%, with 14.8% of patients undergoing reoperation. Maximum results were seen 2 years after conversion, outranging RYGB: %EWL of 78.3% ± 24% with percent total weight loss (%TWL) of 35.9% ± 11.9% and %EWL of 72% ± 24.1% with %TWL of 32.6% ± 11%, respectively. The 5-year weight of all the patients (85.7% follow-up) remained lower than the pre-conversion weight. Over time, 1 reversal and 4 revisions were required, and frequent stools and gastroesophageal reflux were the most frequent complaints. Despite its complexity, conversion of RYGB to BPD-DS can be performed in 1 stage, although the use of an unconventional technique could not reduce the high complication rate. BPD-DS remains an efficient procedure after RYGB in selected patients, comparable to distalization of RYGB, which can be less risky. • Weight regain can happen after RYGB without technical issues Conversion to BPD-DS can be performed as one-stage in all the cases. There is a high 30-day complication rate of 25% "Hybrid sleeve" did not show any benefit compared to conventional gastro-gastric anastomosis with sleeve gastrectomy. • Long-term weight loss results after conversion are on par with the best ones after the initial RYGB. [ABSTRACT FROM AUTHOR]

Objective: To investigate the way robotic assistance affected rate of complications in bariatric surgery at expert robotic and laparoscopic surgery facilities. Background: While the benefits of robotic assistance were established at the beginning of surgical training, there is limited data on the robot's influence on experienced bariatric laparoscopic surgeons. Methods: We conducted a retrospective study using the BRO clinical database (2008--2022) collecting data of patients operated on in expert centers. We compared the serious complication rate (defined as a Clavien score≥3) in patients undergoing metabolic bariatric surgery with or without robotic assistance. We used a directed acyclic graph to identify the variables adjustment set used in a multivariable linear regression, and a propensity score matching to calculate the average treatment effect (ATE) of robotic assistance. Results: The study included 35,043 patients [24,428 sleeve gastrectomy (SG); 10,452 Roux-en-Y gastric bypass (RYGB); 163 single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S)], with 938 operated on with robotic assistance (801 SG; 134 RYGB; 3 SADI-S), among 142 centers. Overall, we found no benefit of robotic assistance regarding the risk of complications (average treatment effect=-0.05, P=0.794), with no difference in the RYGB+SADI group (P=0.322) but a negative trend in the SG group (more complications, P= 0.060). Length of hospital stay was decreased in the robot group (3.7±11.1 vs 4.0 ±9.0 days, P<0.001). Conclusions: Robotic assistance reduced the length of stay but did not statistically significantly reduce postoperative complications (Clavien score≥3) following either GBP or SG. A tendency toward an elevated risk of complications following SG requires more supporting studies. [ABSTRACT FROM AUTHOR]

During the past years, 2 alternatives to the powerful but side-effect-prone biliopancreatic diversion with duodenal switch (BPD-DS) were developed: one-anastomosis duodenal switch (OADS) and sleeve gastrectomy with transit bipartition (TB). To compare the 1-year results of TB and BPD-DS aiming at reducing the risk of protein malnutrition while keeping a similar weight loss for body mass index (BMI) ≥50 kg/m2. Private hospital, single-surgeon practice in a bariatric surgery center. After a change in practice in 2017, the last 71 primary BPD-DS and the first 71 TB in patients with a BMI ≥50 kg/m2 were retrospectively compared. Postoperative course, side effects, nutritional status, and need for revision and weight outcomes were reviewed. Weight was expressed as BMI, percentage of excess BMI lost, and percentage of total weight lost. TB was faster to perform (92 versus 149 min, P <.0001) with a comparable 30-day complication rate of 4.3% and 5.7%. TB patients had a shorter hospital stay (2.3 ± 1 versus 4.5 ± 3.4 d, P <.0001). At 1 year, weight loss was significantly lower after TB compared with BPD-DS with percentage of excess BMI loss of 83.7 ± 12.2% versus 78.6 ± 14.7% (P =.0023). Two patients were lost to follow-up after BPD-DS and 6 after TB. Seven BPD-DS patients were treated for protein malnutrition, whereas only 2 patients had severe side effects after TB. Only 7% of the TB patients experienced >3 stools a day compared with 33% after BPD-DS (P =.016). There was no significant difference in terms of co-morbidity improvement at 1 year: 81.8% and 61.9% of patients had remission of blood hypertension, 9% and 14.3% had improvement, type 2 diabetes was in remission in 90% and 88%, and obstructive sleep apnea in 84% and 78% of the TB and BPD-DS patients, respectively. Although 1-year weight loss was significantly lower when BMI was ≥50, the real benefit of TB is the reduction of the side effects and protein malnutrition compared with BPD-DS. TB represents a much simpler alternative to BPD-DS for treating superobesity with less risk of major complications, but prospective studies and longer follow-up are required to confirm the maintenance of the weight loss in the long term. In superobesity, 1-year weight loss is 6% better in BPD-DS than in TB. Comorbidity remissions were the same in this series between TB and BPD-DS Different than BPD-DS, TB was simpler and faster, with no major complications Less side-effects and protein malnutrition after TB than in BPD-DS [ABSTRACT FROM AUTHOR]

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Background The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was designed in 2007 to reduce the side effects of biliopancreatic diversion with duodenal switch (BPD-DS) by replacing the Roux-en-Y construction with a single duodeno-ileal anastomosis and combining the common channel with the alimentary limb. Several variants using different channel lengths were published. The objective of this study was to identify the published cases of SADI-S and variants and assess the results regarding potential benefits on side effects and revisions. Methods PubMed, ClinicalTrials.gov , and the databases of 3 relevant surgical journals were searched for any publication from 2007 to date. Results In all, 19 studies were analyzed. After identifying overlaps, 1,041 patients among 9 institutions were identified: 304 with SADI-S, 667 with stomach intestinal pylorus sparing surgery, and 70 with single anastomosis duodenojejunal bypass with sleeve gastrectomy. There were no postoperative deaths and the early complication rate was 7.3% (range 1.6–14%). The mean operative time was 100.8 minutes (range 69.9–181.7 min). The mean 1-year percentage of excess weight loss (%EWL) was 78.7% (range 61.6–87%) and percentage of total weight loss (%TWL) was 36.8% (range 32.7–41.1%). Two studies reported a 2-year %TWL of 38.7% and a single study reported a 5-year %TWL of 37%. A total of 50% of patients had biological data at 1 year. One retrospective study found no difference between BPD-DS and SIPS for vitamin deficiency at 2 years, but there was less severe diarrhea and malnutrition after SIPS. The revision rate increased from 2% to 7% after SADI-S between 2- and 5-year follow-up. Conclusion There are still limited long-term data available for single anastomosis duodenal switch. In the absence of published prospective randomized trials, no evidence exists in favor of this variant of the BPD-DS despite a possible trend in less malabsorption side effects. [ABSTRACT FROM AUTHOR]