Revisional Surgical Options After Single Anastomosis Sleeve Jejunal Bypass for Refractory Biliary Reflux: A Prospective Comparative Study Between Roux-en-Y Gastric Bypass and Reversal to Sleeve Gastrectomy.

BACKGROUND

After Single Anastomosis Sleeve Jejunal (SASJ) bypass, biliary reflux is a challenging postoperative issue that may require revisional intervention. Conversion to Roux-en-Y gastric bypass (RYGB) and revision to sleeve gastrectomy are two frequently used techniques. Their clinical results are assessed and contrasted in this study.

MATERIALS AND

METHODS

Forty patients were the subject of a prospective comparative analysis presenting with persistent biliary reflux after SASJ despite medical therapy. Patients were managed by either conversion to RYGB (Group A, n = 22) or revision to sleeve gastrectomy (Group B, n = 18). Reflux resolution, gastroesophageal reflux disease (GERD), perioperative outcomes, and weight changes were among the outcomes evaluated over a 12-month period.

RESULTS

The two groups' baseline characteristics were comparable (p > 0.05). The RYGB group had significantly longer operating times and longer hospital stays (p < 0.001 and p = 0.036). While 27.8% of patients in the sleeve group had persistent reflux, all patients undergoing RYGB showed complete resolution of biliary reflux (p = 0.008). GERD outcomes improved in Group A but significantly worsened in Group B (p = 0.007). Weight evolution favored RYGB, demonstrating sustained BMI reduction, while sleeve revision was associated with progressive weight regain.

CONCLUSION

RYGB conversion was associated with more reliable reflux resolution and better overall clinical outcomes compared with sleeve revision. To validate these results, more extensive research is needed.