Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Impact on Reflux and Weight Loss

Background Sleeve gastrectomy (SG) is the most commonly performed weight loss operation and its two most common complications are postoperative reflux and weight recurrence. There is limited evidence to guide decision-making in treating these conditions. Objective To determine the efficacy of conversion of SG to Roux-en-Y gastric bypass (RYGB) for GERD management and weight loss. Setting Forty-one hospitals in Michigan Methods We conducted a retrospective cohort study examining patients who underwent conversion of SG to RYGB from 2014 to 2022. The primary outcomes were changes in GERD-HRQL scores, anti-reflux medication use, and weight from baseline to one year after conversion. Secondary outcomes included 30-day postoperative complications and resource utilization. Results Among 2,133 patients undergoing conversion, 279 (13%) patients had baseline and one-year GERD-HRQL survey data and anti-reflux medication data. GERD-HRQL scores decreased significantly from 24.6 to 6.6 (p<0.01). Among these, 207 patients (74%) required anti-reflux medication at baseline, with only 76 patients (27%) requiring anti-reflux medication at one year postoperatively (p<0.01). Of the 380 patients (18%) with weight loss data, mean weight decreased by 68.4lbs, with a 24.3% decline in total body weight and 51.5% decline in excess body weight. In terms of 30-day complications, 308 (14%) of patients experienced any complication and 89 (4%) experienced a serious complication, but there were no leaks, perforations, or deaths. Three-hundred and fifty-five (17%) patients presented to the emergency department and 64 (3%) patients underwent reoperation. Conclusions This study represents the largest reported experience with conversion from SG to RYGB. We found that conversion to RYGB is associated with significant improvement in GERD symptoms, reduction in anti-reflux medication use, and significant weight loss and is therefore an effective treatment for GERD and weight regain after SG. However, the risks and benefits of conversion surgery should be carefully considered, especially in patients with significant comorbidity burden.