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Published on: February 10, 2023
Revisional Surgical Options After Single Anastomosis Sleeve Jejunal Bypass for Refractory Biliary Reflux: A
Mohamed A Elshimy1, Ahmed M Farrag2, Gamal M Abdalla2
1Ain Shams University, Cairo, Egypt. drmohamed89elshimy@gmail.com.
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.
