Conversion to One-Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass for Treatment of Gastroesophageal Reflux Disease after Sleeve Gastrectomy: A Systematic Review and Meta-analysis.

BACKGROUND

Sleeve gastrectomy (SG) may precipitate or worsen gastroesophageal reflux disease (GERD), sometimes necessitating conversion to gastric bypass. Both Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) have been proposed as revisional procedures, yet comparative data on GERD outcomes remain limited.

METHODS

This study encompassed analysis of PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, and ClinicalTrials.gov from database inception through November 2024. Studies comparing OAGB with RYGB as conversion procedures after failed SG were included. Primary outcomes were GERD resolution rate and de novo GERD incidence. Secondary outcomes included weight loss parameters (%TWL, %EWL), metabolic outcomes, operative time, complications, and reoperation rates. Random-effects meta-analysis was performed using RevMan 5.4.

RESULTS

Ten studies met inclusion criteria, comprising 1,556 patients: 739 undergoing revisional OAGB and 817 revisional RYGB. Follow-up ranged from 12 to 60 months. GERD resolution rates were comparable between revisional OAGB (68.6%, 81/118) and revisional RYGB (80.6%, 150/186), with no significant difference (risk difference = 0.10, 95% CI -0.04 to 0.24, p = 0.19, I²=96%). However, de novo GERD showed a trend toward higher incidence after conversion to OAGB (6.3%, 16/255) compared to conversion to RYGB (0.5%, 1/180) (risk difference = -0.23, 95% CI -0.57 to 0.11, p = 0.16, I²=92%). Conversion to OAGB demonstrated significantly greater weight loss compared to conversion to RYGB (MD = + 5.70% TWL, 95% CI 4.84 to 6.57, p < 0.00001, I²=0%). Operative time was significantly shorter for conversion to OAGB (MD = -24.79 min, 95% CI -32.11 to -17.47, p < 0.00001, I²=92%). No significant differences were observed in leak rates, bleeding, or marginal ulceration.

CONCLUSIONS

Conversion to OAGB provides GERD symptom relief comparable to conversion to RYGB, with similar resolution rates in patients with established reflux. However, RYGB may be preferable when definitive GERD treatment is the primary indication, given the trend toward lower de novo GERD risk. Conversion to OAGB offers advantages in weight loss efficacy and shorter operative time. The choice should be individualized based on patient-specific factors and primary indication for revision.