Conversion to Roux-En-Y Gastric Bypass: a successful means of mitigating reflux after laparoscopic sleeve gastrectomy

Mar 30, 2023Surgical endoscopy

Switching to Roux-En-Y Gastric Bypass helps reduce acid reflux after sleeve gastrectomy surgery

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Abstract

97 patients underwent conversion from laparoscopic sleeve gastrectomy to Roux-En-Y gastric bypass between January 2015 and December 2021.

The cohort was predominantly female, comprising 91.7% of the patients, with an average age of 42.7 years at conversion.
The main reasons for revision were gastroesophageal reflux disease (GERD) in 72.2% of cases and obesity or insufficient weight loss in 24.7%.
Patients experienced an average weight loss of 11.1 kg after the conversion to Roux-En-Y gastric bypass.
Among those revised for GERD, 80.2% reported improvement in symptoms after the procedure.
19.4% of patients who were taking proton pump inhibitors (PPIs) were able to discontinue their use postoperatively.

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INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric procedure due to the technical ease and weight loss success of the operation. However, there has been concern that LSG contributes to gastroesophageal reflux disease (GERD) postoperatively with a proportion of patients requiring conversion to a Roux-En-Y Gastric Bypass (RYGB). The objective of this study was to characterize the patients who underwent revision in our hospital system and to better understand pre-operative predictors of GERD and revision.

METHODS: After IRB approval, a retrospective review was conducted assessing for patients who had conversion of LSG to RYGB at three hospitals within the University of Pennsylvania Health System from January 2015 to December 2021. The patients' charts were then reviewed to evaluate for demographics, BMI, operative findings, imaging and endoscopic reports, and post-operative outcomes.

RESULTS: 97 patients were identified who underwent conversion of LSG to RYGB between January 2015 and December 2021. The cohort was predominantly female (n = 89, 91.7%) with an average age of 42.7 ± 10.6 years at the time of conversion. The most common indications for revision were GERD (72.2%) and obesity/insufficient weight loss (24.7%). Patients lost an average of 11.1 ± 12.9 kg after revision to RYGB. Of the patients who underwent revision for GERD, 80.2% noted global symptomatic improvement after revision and 19.4% were able to stop their proton pump inhibitor (PPI) postoperatively, with most patients decreasing the frequency of the PPI use postoperatively.

CONCLUSION: The majority of patients who underwent conversion from LSG to RYGB due to GERD and saw marked improvements in GERD symptoms and outcomes. These findings illuminate the real-world practices and outcomes of bariatric revisional procedures for reflux and the need for more research on standardized practice.

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Conversion to Roux-En-Y Gastric Bypass: a successful means of mitigating reflux after laparoscopic sleeve gastrectomy

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