Magnetic sphincter augmentation versus conversion to Roux-en-Y gastric bypass for gastroesophageal reflux disease following sleeve gastrectomy in patients with body mass index <30: A single-center comparative study

BACKGROUND: Gastroesophageal reflux disease (GERD) affects 20%-30% of patients after sleeve gastrectomy (SG). In patients with a body mass index (BMI) <30 kg/m2, the optimal surgical approach-magnetic sphincter augmentation (MSA) or conversion to Roux-en-Y gastric bypass (RYGB)-remains unclear. METHODS: We retrospectively compared outcomes of MSA (n = 20) and RYGB (n = 25) in patients with BMI <30 kg/m2 and refractory post-SG GERD at King Abdulaziz University Hospital (2019-2024). Inclusion required objective evidence of GERD despite ≥6 months of optimized proton pump inhibitor therapy. The primary outcome was GERD resolution. Secondary outcomes included proton pump inhibitor cessation, complications, weight trajectory, and diabetes remission at a minimum follow-up of 18 months. RESULTS: GERD resolution occurred in 70% of patients who underwent MSA and 85% of those who underwent RYGB. Proton pump inhibitor cessation rates were 65% and 80%, with lower postoperative GERD-health-related quality of life (HRQL) scores in the RYGB group. Early dysphagia was more common after MSA (30% vs. 4%). MSA was associated with weight stability, whereas RYGB resulted in significant weight reduction. Diabetes remission occurred in 75% of patients, who underwent RYGB. CONCLUSION: Both procedures effectively managed post-SG GERD in patients with low BMI. MSA offers weight-neutral reflux control, shorter operative time, and no supplementation requirements. RYGB provides superior symptom control and metabolic benefits, including diabetes remission.