BackgroundLaparoscopic sleeve gastrectomy (LSG) is a common bariatric procedure for weight loss. LSG is becoming prevalent worldwide because it is a relatively simple procedure with high efficacy. Reduced intraabdominal pressure may improve gastroesophageal reflux disease (GERD) symptoms and reduce the GERD medication needed following LSG. However, the main long-term drawback of LSG is the development of de novo GERD. Therefore, we conducted this study to determine the relationship between GERD symptoms and LSG. MethodsWe conducted a retrospective chart review involving 390 patients who underwent LSG. Study participants were evaluated for GERD symptoms six months before and three, six, and nine months after the procedure, and proton-pump inhibitors (PPIs) were used to control the symptoms. Participants were distributed into two groups: one group for patients with GERD symptoms (36.1%) and one group for asymptomatic patients (62.8%). We collected demographic data and assessed PPI use in both groups after three, six, and nine months postoperatively. Data were collected using Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). We compared data using the student's t-test for independent groups. The quantitative data were summarized using mean and standard deviation (SD), and p < 0.05 was considered statistically significant. ResultsOf the 390 participants who underwent LSG, 83.8% were women (n=327) and 16.2% were men (n=63), with a median age of 42 ± 11.9 years. PPI use was statistically significantly greater after LSG (34.1%) than before LSG (24.6%, p=0.019). The difference in PPI use between symptomatic and asymptomatic groups was not statistically significant three months after LSG. ConclusionsOur study focuses on using PPI after LSG due to GERD symptoms. We found GERD symptoms improved three months following LSG, but de novo GERD symptoms occurred nine months after the surgery. Health providers need to discuss with their patients the potential outcomes of the surgery and manage patient expectations. Physicians should work with their patients to assess whether the benefits of bariatric surgery in controlling overweight-associated conditions, such as blood pressure, diabetes, sleep apnea, and weight loss, outweigh the risk of GERD symptoms and PPI use.
IntroductionGallbladder disease (GBD) encompasses several medical conditions, including gallbladder stone formation, biliary colic, and cholecystitis. These conditions may arise following bariatric surgery, including bypass or laparoscopic sleeve gastrectomy (LSG). The development of GBD after surgery may be attributed to various factors, including the formation of stones shortly after the procedure, the exacerbation of existing stones due to the surgery, or inflammation of the gallbladder. Rapid weight loss after surgery has also been proposed as a contributing factor. MethodologyThis observational study consisted of a review of retrospective hospital patient medical records of 350 adult participants who underwent LSG, with 177 participants included in the study after excluding those with cholecystectomy or GBD prior to surgery. The participants were followed for a median of two years, during which we recorded any hospitalizations, emergency department visits, clinic visits, and incidents of cholecystectomy or abdominal pain due to GBD. The participants were grouped into two: those with GBD and those without GBD after bariatric surgery, and quantitative data were summarized using mean and standard deviations. The data were analyzed using IBM SPSS Statistics for Windows, Version 20.0. (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp), with a statistical significance of P<0.05. ResultsIn our retrospective study of 177 patients who underwent LSG, the incidence of GBD after bariatric surgery was 4.5%. Most patients with GBD after bariatric surgery were White, but this difference was not statistically significant. Patients with type 2 diabetes had a higher incidence of GBD after bariatric surgery than those without diabetes (8.3% vs. 3.6%, P=0.355). Patients with HTN had a lower incidence of GBD after bariatric surgery than those without HTN (1.1% vs. 8.2%, P=0.032). Anti-hyperglycemia medication use did not significantly increase the risk of GBD after bariatric surgery (7.5% vs. 3.8%, P=0.389). None of the patients on weight loss medication developed GBD after bariatric surgery, compared to 5% of patients who did not take weight loss medication. Our sub-data analysis showed that patients who developed GBD after bariatric surgery had a high BMI (above 40 kg/m2) before surgery, which decreased to 35 kg/m2 and below 30 kg/m2 at six months and 12 months post-surgery, respectively. ConclusionsOur findings demonstrate that the prevalence of GBD after LSG is low and comparable to the general population without LSG. Thus, LSG does not increase the risk of GBD. We found that rapid weight loss after LSG is a significant risk factor for GBD. These findings suggest that patients who undergo LSG should be informed of the risks of GBD and undergo careful screening before surgery to detect any pre-existing gallbladder issues. Overall, our study highlights the importance of continued research into the factors associated with GBD after bariatric surgery and the need for standardized proph...
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