Background

Gastroesophageal reflux disease (GERD) is a common problem after bariatric surgery with some patients requiring a reoperation due to inadequate symptom control with medications. We aimed to assess the GERD outcomes after revisional bariatric surgery.

Methods

The outcomes of patients from an academic MBSAQIP center of excellence who underwent elective revisional surgery for GERD after a primary bariatric procedure between 2018 and 2020 were reviewed. Basic descriptive statistics were used for the interpretation of the results.

Results

47 patients with GERD following bariatric surgery were included in the study, with 93.6% being female and 51.6 ± 1.7 years old. In 53.2% of patients, GERD was the only indication for surgery, while in 46.8%, weight recurrence, inadequate weight loss, and marginal ulcers were present in addition to GERD. Revisions consisted of conversion of sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) (57.5%), band to RYGB (14.9%), vertical banded gastroplasty (VBG) to RYGB (14.9%), band to SG (6.4%), and RYGB revision (6.4%). 17% of patients experienced perioperative complications, 21.3% were readmitted, 6.4% underwent an intervention, one was reoperated (2.1%) and there was no mortality. While >90% of patients saw improvement in their GERD symptoms postoperatively, 56.8% were still on PPIs at 6 months and 76.2% at 1 year postoperatively.

Conclusions

While reflux symptoms improve in the majority of patients after revisional surgery for postoperative GERD, most patients remain on PPIs 1 year later. Further clinical trials are needed to determine the type of surgery that maximizes GERD resolution for this patient population.