Abstract Background Laparoscopic sleeve gastrectomy represents the most commonly performed bariatric procedure worldwide, primarily due to its relative simplicity and lower complication rates. The literature reflects a broad range of conversion rates from laparoscopic sleeve gastrectomy to alternative bariatric procedures, with reported values fluctuating between 2.5% and 33%. Weight regain and inadequate weight loss are identified as the primary reasons for approximately 70% of revision surgeries following laparoscopic sleeve gastrectomy. Gastroesophageal reflux disease (GERD) is reported as the second most common cause for surgical revision. The objective of this study was to assess the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) as a revisional procedure for the management of gastroesophageal reflux in patients who had previously undergone laparoscopic sleeve gastrectomy, irrespective of any weight regain experienced. Methods This Prospective pilot study was conducted on 32 patients from December 2022 until December 2024, and they were divided into three groups: Group Ⅰ: sixteen patients who complained of GERD symptoms only without weight regain underwent R-RYGB with biliopancreatic limb 75 cm and alimentary limb 75 cm without counting rest of bowel, Group Ⅱ: eleven patients who complained of GERD symptoms and weight regain but BMI 50 kg/m² underwent R-RYGB with biliopancreatic limb 150 cm and common limb 300 cm without counting alimentary limb, Group Ⅲ: five patients who complained of GERD symptoms and weight regain but BMI 50 kg/m² underwent R-RYGB with biliopancreatic limb 200 cm and common limb 300 cm without counting alimentary limb. Results a total of thirty-two patients were enrolled in the study. Group 1 patients underwent R-RYGB within 38.37 ± 11.17 months post-SG, compared to 37.91 ± 17.36 months in Group 2 and 35.8 ± 7.52 months in Group 3. At R-RYGB, group 3 patients had a mean BMI of 51.4 ± 0.93 kg/m², compared to group 2, which had a mean BMI of 39.45 ± 2.58 kg/m², and group 1 had a BMI of 29.3 ± 1.66 kg/m². Preoperative upper endoscopy, performed before revisional RYGB, revealed that all 32 patients (100%) had a hiatal hernia, while esophagitis was observed in 21.9%, an incompetent cardia in 25%, antral gastritis in 18.8%, and Barrett’s esophagus in 3.1%. There were slightly higher rates of esophagitis, incompetent cardia, and antral gastritis in the GERD group. Only one case of Barrett’s esophagus was found in the GERD group. Patients in the GERD group had a lower mean haemoglobin level (11.79 ± 1.62 g/dL) and slightly reduced serum albumin (3.50 ± 0.44 g/dL), suggesting possible subclinical iron deficiency and mild protein malnutrition. In contrast, patients in the weight regain groups, particularly those with a BMI 50 kg/m², had higher hemoglobin (13.52 ± 0.42 g/dL) and ferritin levels (116.46 ± 45.61 ng/mL), reflecting better overall nutritional status—likely related to higher caloric and nutrient intake. Albumin levels across all groups remained within the low-normal to normal range. Glycemic control, as measured by HbA1c levels, was effectively maintained across all subgroups, with no values exceeding 5.1%. Additionally, thyroid function tests (TSH) remained within the normal physiological range. The GERD group had a mean GERD-HRQL score of 53.37 ± 5.18, indicating severe reflux symptoms with substantial impact on daily functioning and well-being.
Elqadeem et al. (Thu,) studied this question.