Background

De-novo gastro-esophageal reflux after SG can be refractory to non-operative treatment. We report a large cohort of patients who underwent conversion from SG to RYGB for refractory reflux symptoms

Methods

Data from all consecutive patients (2018-21) who underwent conversion from SG to RYGB for refractory reflux as the primary indication were reviewed; concomitant hiatal hernias were diagnosed endoscopically or radiographically. Demographic data, time from index SG, percent total body weight loss (%TBWL), BMI and 30-day MBSAQIP complications were recorded. Post-op PPI use and improvement of reflux, nausea, vomiting, dysphagia, or abdominal pain were compared with McNemar statistical test. Data are mean± standard deviation.

Results

64 patients (92% female; 48±10 years) underwent conversion to RYGB and repair of concomitant hiatal hernias 4±3 years after the index SG. At 7±4 months post-conversion to RYGB, TBWL% was 14±10% and BMI decreased from 37±7 to 32±6 Kg/m2. Reflux symptoms and PPI use declined by 77% (p<0.0001) and 49% (p<0.001), respectively. Nausea, vomiting, dysphagia, and abdominal pain decreased by 13%, 23%, 19% and 11%, respectively (Table). Post-op complications were wound infection, port site hernia, SBO, dislodged feeding tube (n=1, each) and bleeding (n=3).

Conclusions

Conversion of SG to RYGB and repair of concomitant hiatal hernia significantly improves reflux symptoms, reduces PPI use, and confers additional weight loss. Nausea, vomiting and dysphagia could persist due to underlying esophageal dysmotility.