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Revisional Roux-en-Y Gastric Bypass After Sleeve Gastrectomy for Gastro-esophageal Reflux Disease and or Insufficient Weight-Loss: a Comparative Study

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Abstract

Introduction

Sleeve gastrectomy (SG) is a popular surgical weight-loss procedure, but there are increasing reports of revisional Roux-Y-gastric-bypass (R-RYGB) to manage weight-loss failure (WLF) or proton pump inhibitor (PPI)–refractory gastroesophageal reflux disease (GERD) after SG, with little data available in these settings.

Methods

This retrospective study included all consecutive patients undergoing R-RYGB for WLF or RGERD after SG in two bariatric care centers from 2012 to 2018.

Results

Of 720 patients, 46 (3.6%) underwent R-RYGB (RGERD, n = 25; 54.4%; WLF, n = 21; 45.6%) within 44.8 ± 27.5 months post-SG. SG had enabled 27% ± 11.6 total weight loss (TWL) in the RGERD group vs. 7.2% ± 12.5% TWL in the WLF group (p < 0.001). At R-RYGB, WLF-group patients had a higher BMI (47.8 ± 8.4 vs. 34.7 ± 6.1 kg/m2; p < 0.001) and a higher number of comorbidities (2.4 ± 1.5 vs 1.5 ± 1.2; p < 0.02) compared to RGERD-group patients, while severe morbidity (Clavien–Dindo ≥ IIIb) was not significantly different between groups (6.5% vs 2.1%, p = 0.6). %TWL was still higher in the RGERD group at 12 months post-R-RYGB (35.6% ± 10.4 vs. 23.8% ± 9.2; p < 0.01) but not after 24 months post-R-RYGB. R-RYGB corrected reflux symptoms in 32 (94%) patients and reduced PPI use in 29 (97%) patients (p < 0.001), with no significant between-group difference. A history of adjustable gastric banding (AGB) (N = 8;17.4%) prior to SG was associated with a similar prevalence of GERD at R-RYGB and a lower %TWL (AGB:13.1 ± 10.2 vs. No AGB:31.6 ± 8.5; p < 0.05) at 3 years post-R-RYGB.

Conclusion

R-RYGB following SG provides remission of reflux symptoms in 94% of patients and extra weight loss in patients with WLF, except in patients with a history of AGB prior to SG.

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Author notes

  1. Adriana Torcivia and Christophe Brevart have equal contribution.

Authors and Affiliations

  1. Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013, Paris, France

    Clément Destan, Clément Baratte, Adriana Torcivia & Laurent Genser

  2. Department of Digestive Surgery, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160, Saint Mandé, France

    Clément Destan, Christophe Brevart & Brice Malgras

  3. Val de Grace Academy, 1 Place Alphonse Laveran, 75005, Paris, France

    Clément Destan, Christophe Brevart & Brice Malgras

  4. Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L’Hôpital, 75013, Paris, France

    Karine Clément, Christine Poitou, Jean-Michel Oppert & Judith Aron-Wisnewsky

  5. INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L’hôpital, Paris, France

    Karine Clément, Christine Poitou, Judith Aron-Wisnewsky & Laurent Genser

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  1. Clément Destan
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Key points

• Indications for R-RYGB after SG were RGERD (54.4%) and WLF (45.6%).

• Prior to R-RYGB, WLF patients had higher BMI and more comorbidities compared to RGERD patients.

• R-RYGB after SG provides significant extra weight loss in WLF patients.

• R-RYGB corrected GERD-related symptoms in 94% of all patients regardless of the indication for conversion.

• A third bariatric procedure (AGB-SG-R-RYGB) was performed in 17.4% of patients and was associated with significantly lower %TWL at three years post-R-RYGB.

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Destan, C., Baratte, C., Torcivia, A. et al. Revisional Roux-en-Y Gastric Bypass After Sleeve Gastrectomy for Gastro-esophageal Reflux Disease and or Insufficient Weight-Loss: a Comparative Study. OBES SURG 33, 3077–3089 (2023). https://doi.org/10.1007/s11695-023-06784-z

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