Weight Loss after Gastric Sleeve to Bypass Conversion

Sally sent us this question: “I had gastric sleeve surgery and have successfully lost my excess weight. I struggle however with severe acid reflux and I need to convert to gastric bypass. What will happen with weight loss?  I don’t have any extra weight to lose. Thank you”

Dear Sally,

Acid reflux after sleeve gastrectomy develops secondary to unrepaired hiatal hernia and/or narrowed gastric sleeve lumen. Fortunately, narrowed gastric sleeves are rarely encountered these days as most bariatric surgeons in Houston have mastered the proper technique of sleeve gastrectomy. A properly performed sleeve gastrectomy is associated with high success rate in terms of weight loss. However, if a concomitant hiatal hernia is not repaired at the time of sleeve gastrectomy, weight loss surgery patients will struggle with severe acid reflux symptoms. Hiatal hernia repair in this situation is more than 95% successful in stopping acid reflux. There is no need to convert a well performed gastric sleeve to gastric bypass to control acid reflux.

In cases of narrowed gastric sleeve lumen, hiatal hernia repair by itself is not enough to control GERD related symptoms. Conversion of gastric sleeve to gastric bypass is required to stop acid reflux. Weight loss, however, following sleeve to bypass conversion is limited. Numerous studies in the literature have shown modest weight loss after sleeve to bypass conversion. Indeed, both sleeve gastrectomy and gastric bypass alter gastrointestinal hormone secretion by increasing gastric emptying into small intestine and stimulating intestinal neuro-hormonal signals that favor weight loss. Both surgeries have overlapping mechanisms for weight loss and there is very little additional weight loss with sleeve to bypass conversion.

In conclusion, acid reflux after sleeve gastrectomy is first managed by repairing the hiatal hernia. Second, if acid reflux persists or if the sleeve lumen is narrowed, sleeve to bypass conversion can be safely performed. Additional weight loss after sleeve to bypass conversion is limited.

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