Predictive Factors of Successful Resolution of Gerd Symptoms after Conversion of Sleeve Gastrectomy to Roux-En-Y Gastric Bypass

Introduction: The development or worsening of GERD post-sleeve gastrectomy (SG) often requires conversion to Roux-en-Y Gastric Bypass (RYGB). This study aimed to identify what preoperative factors are associated with resolution of GERD symptoms after conversion operation. Methods: This was a retrospective, single-center study and the largest case series of SG patients who underwent conversion to RYGB from 2015-2022. Postoperative GERD resolution was assessed based on patient BMI, time of GERD onset, preoperative medication usage, and preoperative hiatal hernia. Results: 66 patients who underwent SG to RYGB conversion operation were identified. Of these patients, 56 (87.5%) reported GERD symptoms before to RYGB. 37/56 (66.07%) patients reported late-onset GERD, defined as onset ≥3 months post- SG. Before to conversion operation, 44/56 (78.56%) patients required GERD medications and 43/56 (76.79%) patients had hiatal hernia. Mean BMI at time of RYGB was 36.71 ± 6.3 kg/m2. 41/56 (73.21%) patients reported post-RYGB resolution of GERD symptoms at a median of 1-month follow-up. Median total follow-up was 6 months. 30 patients completed pre- and post-RYGB GIQLI surveys, which showed significant improvement in GIQLI scores after RYGB (93.37 vs 102.2, p= 0.0009). BMI at time of operation, use of GERD medications, existing hiatal hernia, and time of reflux were not significantly associated with lack of resolution of symptoms. Conclusion: A majority of patients presented with late-onset GERD, emphasizing the importance of continued postoperative follow-up. Most patients experienced resolution of GERD symptoms shortly after RYGB, suggesting that this procedure is highly successful regardless of patients’ preoperative characteristics.