Sleeve to gastric bypass conversion: a multiinstitutional study of 217 patients.

Background: Revision of a sleeve gastrectomy (SG) to a Roux-en-Y gastric bypass (RYGB) is indicated for gastroesophageal reflux disease (GERD) and for weight recurrence. Existing literature is conflicting and lacks long-term follow-up.

Objectives: To evaluate the resolution of GERD and additional weight loss after conversion of SG to RYGB.

Setting: Retrospective study of prospectively maintained multicentric bariatric surgery data sets.

Methods: Patients who underwent a conversion from SG to RYGB were divided in two groups based on the indication (GERD versus weight). Outcomes included total weight loss (TWL), GERD symptoms resolution, nutritional parameters, and postoperative complications such as reoperations and readmissions. The outcomes were compared between both groups.

Results: One hundred twenty-four patients with GERD versus 93 weight patients were included in the study. At the time of the revision, the weight group had a significantly higher body mass index (BMI) (42.3 ± 5.5 versus 34.7 ± 6.6kg/m, P < .0001). Both groups achieved comparable TWL following the revision (GERD:13 ± 8% versus weight 16 ± 7%, P = .529; 23/93 lost to follow-up in the weight group). At the 1-year follow-up, more than 75% of the patients had their GERD symptoms resolved (18/124 lost to follow-up). For postoperative outcomes, immediate postoperative complications were comparable between both groups (P = .754). Over an average follow-up period of 4 years following the revision, patients with GERD had more late reoperations (GERD: 14% versus weight: 4%, P = .016).

Conclusions: SG-to-RYGB conversion for GERD or weight recurrence helped achieve resolution of GERD symptoms as well as additional weight loss. GERD patients suffered from worse clinical outcomes following a revision RYGB in comparison to the weight recurrence patients.