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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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Abstract

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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Funding

There were no primary sources of funding for this study.

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Authors and Affiliations

  1. Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Alexandra L. Strauss

  2. Fox Chase Cancer Center, Philadelphia, PA, USA

    Joseph R. Triggs

  3. Department of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Colleen M. Tewksbury

  4. Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Ian Soriano

  5. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    David S. Wernsing, Kristoffel R. Dumon, Noel N. Williams & Jenny M. Shao

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  1. Alexandra L. Strauss
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  2. Joseph R. Triggs
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  3. Colleen M. Tewksbury
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  4. Ian Soriano
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  5. David S. Wernsing
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  6. Kristoffel R. Dumon
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Correspondence to Jenny M. Shao.

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Disclosures

Dr. Ian Soriano has disclosures including serving as a proctor for Intuitive Surgical and consulting for Surgimatrix. Dr. Jenny Shao has disclosures including educational honoraria for Medtronic, Consulting Honoraria for AbbVie, and a Intuitive Foundation Research Grant which has concluded. Drs. Alexandra Strauss, Joe Triggs, Wernsing, Colleen Tewksbury, Kristoffel Dumon, Noel Williams ave no conflicts of interest or financial ties to disclose.

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Strauss, A.L., Triggs, J.R., Tewksbury, C.M. et al. Conversion to Roux-En-Y Gastric Bypass: a successful means of mitigating reflux after laparoscopic sleeve gastrectomy. Surg Endosc 37, 5374–5379 (2023). https://doi.org/10.1007/s00464-023-10024-x

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  • DOI: https://doi.org/10.1007/s00464-023-10024-x

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