Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss

Jan 8, 2017Obesity surgery

Changing Sleeve Gastrectomy to Gastric Bypass helps acid reflux but not extra weight loss

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Abstract

In a cohort of 22 patients, 100% reported improvement in gastro-esophageal reflux disease (GERD) symptoms after conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB).

Ten out of 22 patients (45.5%) converted for GERD, while 11 patients (50.0%) converted due to inadequate weight loss (IWL)/weight regain (WR).
Patients converted for GERD had a lower average body mass index (BMI) of 30.5 compared to 43.3 for those converted for IWL/WR.
Eighty percent of patients in the GERD group were able to discontinue antacid medications post-conversion.
Two years after surgery, the IWL/WR group experienced a BMI reduction of 2.5 points, while the GERD group had a reduction of 2.0 points.
Final BMI was 40.8 for the IWL/WR group and 28.5 for the GERD group.

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INTRODUCTION: Inadequate weight loss (IWL)/weight regain (WR) and gastro-esophageal reflux disease (GERD), unresponsive to medical management, are two most common indications for conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB). This study reports detailed outcomes of conversion of SG to RYGB for these two indications separately.

METHODS: We interrogated our prospectively maintained database to identify patients who underwent a conversion of their SG to RYGB in our unit. Outcomes in patients converted for IWL/WR and those converted for GERD were evaluated separately.

RESULTS: We carried out 22 SG to RYGB in our unit between Aug 2012 and April 2015 with a mean follow-up of 16 months. Indication for conversion was GERD in 10/22 (45.5%) patients and IWL/WR in 11/22 (50.0%) patients. Patients undergoing conversion for GERD were significantly lighter (BMI 30.5) than those converted for IWL/WR (BMI 43.3) at the time of conversion. The conversion was very effective for GERD with 100% patients reporting improvement in symptoms, and 80% patients were able to stop their antacid medications. IWL/WR group achieved a further BMI drop of 2.5 points 2 years after surgery (final BMI 40.8) in comparison with 2.0 points BMI drop achieved by the GERD group (final BMI 28.5).

CONCLUSION: This study demonstrates that conversion of SG to RYGB is effective for GERD symptoms but not for further weight loss, which was modest in both groups. Future studies need to examine the best revisional procedure for IWL/WR after SG.

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Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass is Effective for Gastro-Oesophageal Reflux Disease but not for Further Weight Loss

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