Current practices in revision/conversion surgery after Roux-en-Y gastric bypass: an international binary expert survey

Abstract

The prevalence of revision and conversion metabolic bariatric surgery (MBS) has increased alongside the growing number of primary Roux-en-Y gastric bypass (RYGB) procedures performed worldwide. Common indications for revision or conversion after RYGB include weight recurrence (WR), suboptimal clinical response (SoCR), and late postoperative complications such as internal hernia, marginal ulcers, malnutrition, dumping syndrome, and post-bariatric hypoglycemia. However, high-quality comparative evidence remains limited, and no international consensus exists regarding optimal management strategies. This study aimed to evaluate current international practices and expert opinions on revision and conversion surgery after RYGB through a global expert survey. This international online binary survey comprised 61 questions and was conducted via SurveyMonkey™ between November 14 and December 10, 2025. A total of 188 specialists participated (75.2% of invitees), with 184 completing the questionnaire (98% completion rate). Item-specific response rates ranged from 177 to 187. The survey demonstrated broad international agreement that WR and SoCR are multifactorial conditions requiring individualized, multidisciplinary management. Endoscopic approaches were generally favored as first-line options in selected patients with anatomical dilation, whereas hypoabsorptive procedures (distal RYGB, SADI-S, BPD-DS) were considered more effective for long-term weight loss and metabolic outcomes. High agreement (> 90%) was observed for multidisciplinary follow-up, individualized procedure selection, lifelong nutritional surveillance, and management of several late complications. Important areas of controversy remain. These findings provide preliminary insights that may support future standardized definitions, clinical pathways, and evidence-based guidelines.