Sleeve to RNY — When Reflux Takes Over

rachelkibble7
Sep 7
2 min read

(Part 5 of 5 in our Revisional Operations Series: Which Surgery for Which Patient?)

Sleeve gastrectomy has helped thousands of patients lose weight and improve their health. But for some, it comes with a frustrating side effect: acid reflux.

While mild reflux can often be managed with lifestyle changes or medication, severe or persistent reflux after sleeve can seriously affect quality of life. For these patients, the best revisional option is usually conversion to Roux-en-Y Gastric Bypass (RNY).

Why Reflux Happens After Sleeve

The sleeve stomach is long and narrow, and it creates higher pressure than the natural stomach. This, combined with the removal of the fundus, can:

Reduce the ability of the stomach to act as a reservoir.
Alter the angle at which the oesophagus meets the stomach.
Increase the chance of acid (and sometimes bile) moving back up.

Even in patients who follow the rules perfectly, reflux can still develop.

When Medication Isn’t Enough

Proton pump inhibitors (PPIs) and lifestyle adjustments are the first line of treatment. But in some patients, symptoms remain severe:

Constant heartburn
Night-time reflux
Cough or hoarse voice from acid irritation
Food intolerance due to reflux and inflammation

At this point, staying with sleeve is no longer fair or safe.

Why RNY is the Revision of Choice

Roux-en-Y bypass works in two key ways:

It diverts bile and acid away from the oesophagus, reducing exposure.
It lowers gastric pressure, meaning less reflux overall.

Patients who revise from sleeve to RNY often report dramatic improvements — not only in reflux symptoms, but also in quality of life.

Important Considerations

RNY is a more complex procedure than sleeve.
Patients need to be prepared for long-term nutritional monitoring and supplementation.
But when reflux is the driving issue, the trade-off is worth it.

The Bottom Line

Reflux is one of the most common long-term complications of sleeve surgery. When it’s severe and medication isn’t enough, RNY is the gold standard revisional procedure.

It doesn’t just improve symptoms — it restores comfort, protects the oesophagus, and allows patients to enjoy life after surgery again.