BackgroundSymptoms of reflux after SG are common and may be refractory to medical treatment. ObjectivesTo assess outcomes of conversion of SG to RYGB with concomitant repair of hiatal hernias on symptoms of reflux. SettingTertiary Community Hospital MethodsWe reviewed data from all consecutive patients (2018-21) who underwent conversion from SG to RYGB for refractory reflux symptoms. Concomitant hiatal hernias were diagnosed endoscopically or radiographically. Improvement in reflux symptoms, nausea, vomiting, dysphagia, or abdominal pain and post-op PPI use were compared with McNemar statistical test. Data are mean± standard deviation. Results64 patients (92% female; 48±10 years) underwent conversion from SG to RYGB and repair of concomitant hiatal hernias 4±3 years after the index SG. A hiatal hernia was detected preoperatively in 57/64 patients (89%) by either UGI, CT scan or EGD.At 29±14 months post-conversion to RYGB, TBWL was 14±9%, EWL was 37±29%, BMI decreased from 37±7 to 32±6 Kg/m2. Symptoms of reflux and use of PPI improved during the early follow up period (median: 14 months; p<0.001) and was sustained at late follow up (median: 32 months; p<0.01). Improvement of nausea and dysphagia reached statistical significance at late follow up (median: 32 months; p<0.01). Vomiting and abdominal pain decreased with time but did not reach statistical significance.Post-op complications were deep surgical site infection (n=3), pulmonary embolism (n=1), bleeding (n=5), reoperation (n=3), and 30-day readmission (n=6). ConclusionsConversion of SG to RYGB and repair of concomitant hiatal hernia improves reflux symptoms, nausea, and dysphagia, reduces PPI use, and confers additional weight loss.