Sleeve gastrectomy with anti-reflux procedures

Abstract

Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results.Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease.Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition.Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors.

Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients

“…The mechanism of LSG on reflux is still debatable. Some propose that LSG can cause or worsen the GERD [ 28 , 29 ], while others believe that obesity is a risk factor for GERD and when one loses weight with LSG, one improves the symptoms of GERD [ 30 ]. One of the limitations of this study is that we did not routinely scope our patients for GERD or evaluated the patients with GERD questionnaire, and this is the main reason we do not have exact numbers describing this complication in this study.…”

Consecuencias clínicas posgastrectomía vertical tubular: enfermedad por reflujo gastroesofágico

“…Chuffart 26 encontró 22% de los síntomas de ERGE de novo. Rengo 43 publicó 60% de la presencia de hernia hiatal después de la cirugía y Felsenreich 44 , confirma hernia hiatal de novo en el 45% y metaplasia de Barrett en 15% de los pacientes, todos con reflujo sintomático; se sugiere que la hernia hiatal preexistente, la ERGE y el esófago de Barrett son contraindicaciones relativas para la GVT [45][46][47][48] . Varios autores han propuesto realizar una reparación de la hernia hiatal concomitante, algún tipo de fundoplicatura para prevenir los síntomas de reflujo de novo.…”

Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis

“…Santoro et al selected obese patients with pre-operative GERD. 84 In addition to a laparoscopic SG they also performed an anti-reflux procedure, consisting of hiatoplasty and cardioplication. They conclude that this M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 21 did not ad any morbidity nor influence weight loss, but that it does lead to a significant reduction in the occurrence of GERD symptoms compared to laparoscopic SG alone, with a mean follow-up of 22 months.…”

“…They conclude that this M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 21 did not ad any morbidity nor influence weight loss, but that it does lead to a significant reduction in the occurrence of GERD symptoms compared to laparoscopic SG alone, with a mean follow-up of 22 months. 84 …”

“…84 All patients were selected on pre-operative GERD and LSG was performed together with antireflux procedure. It is unknown what the exact pre-and postoperative prevalence of GERD in control group is.…”