Does hiatal repair affect gastroesophageal reflux symptoms in patients undergoing laparoscopic sleeve gastrectomy?

Abstract

In the medium term, GERD-HRQL improves following sleeve gastrectomy with meticulous hiatal assessment and repair of hiatal laxity and herniation.

A prospective study of gastro-oesophageal reflux disease symptoms and quality of life 1-year post-laparoscopic sleeve gastrectomy

“…Dissection of the overlying peritoneum was carried out as required. [2] If present a hiatus hernia was repaired using anterior 0 Ethibond sutures (Johnson and Johnson Medical, New Brunswick NJ, USA), the posterior hiatus was also inspected and repaired as required. If no hiatal hernia was present, the phreno-oesophageal ligament was preserved.…”

“…Concerns exist that LSG may worsen or provoke gastro-oesophageal reflux disease (GORD). [12] This also has been a concern for other restrictive bariatric procedures including laparoscopic-adjustable gastric banding. [12] A systemic review and meta-analysis suggest paradoxical outcomes for GORD in patients after LSG.…”

“…[12] This also has been a concern for other restrictive bariatric procedures including laparoscopic-adjustable gastric banding. [12] A systemic review and meta-analysis suggest paradoxical outcomes for GORD in patients after LSG. [1] Although weight loss often alleviates GORD symptoms through reduced intra-abdominal pressure, the potential for decreased gastric emptying and increased intraluminal pressure may lead to GORD.…”

“…This may partially explain the heterogeneous reported results between and within studies. [12] The aim of this pilot study was to assess patient-reported outcomes of GORD symptoms and quality of life for 1-year post-LSG.…”

Gastroesophageal Reflux Before Metabolic Surgery

“…Therefore, there was no correlation between clinical signs and the presence of imaging or endoscopic changes, a circumstance that may cause underestimation of the prevalence of GERD in obese patients (5). On the other hand, in the context of epidemic obesity, we find a significant increase in the use of metabolic surgery, especially of laparoscopic gastric sleeve (LSG) procedures (6), and the influence of these operations on GERD is of concern and a lot of debate in literature (7)(8)(9)(10)(11). Consequently, preoperative extensive evaluation of GERD in bariatric patients is mandatory for establishing surgical treatment (type of metabolic surgery, hiatal hernia repair), but also for accurate reporting of BRGE progression following such operations and postoperative weight loss.…”