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

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.