Background

The incidence of GERD after SG is reported to be up to 35%, being RYGB conversion as the procedure of choice. We aim to determine the incidence of long-term reflux symptoms, PPI use, and weight changes after conversion of SG to RYGB (C-RYGB). Also, identify the factors associated with persistent reflux symptoms.

Methods

We performed a retrospective analysis of patients who underwent C-RYGB at our institution from 2015 to 2023. The patient’s charts were then reviewed to evaluate for symptoms, PPI use, and weight-related data.

Results

103 patients (86% female; 53.1±11.9 years) underwent C-RYGB (86 reflux; 17 IWL) with a mean BMI of 35.7+7.1 kg/m2. 79.4% (n=81) of patients had a repair of concomitant hiatal hernia (32.1% recurrent HH). At 14±9 months of follow-up, 83.7% had a success rate for resolution of reflux symptoms (p<.005), and 44.1% were able to stop PPI use (p<.005) (Figure 1). Dysphagia, nausea/vomiting, and abdominal pain decreased by 31%, 18%, and 4%, respectively. Only 2 (1.9%) HH recurred and were asymptomatic. In addition, TWL% and EWL% were 14.4% and 39.1%, respectively. Factors associated with post-conversion reflux were an average time to conversion >7 years (OR 4.25), reflux before SG (2.92), and PPI use twice per day (OR 1.48).

Conclusions

While C-RYGB markedly improves reflux symptoms and reduces PPI use, it doesn’t confer optimal long-term weight loss. Average time to conversion, reflux before SG, and PPI use were associated with persistent reflux. Conversion to RYGB should be considered an effective surgical option for post-sleeve reflux.