Gastroesophageal Reflux Disease and Hiatal Hernia After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study

Abstract

Introduction: Laparoscopic sleeve gastrectomy (LSG) has shown good results in terms of weight loss and improvement of obesity-comorbidities, even though its effect on inducing new-onset gastroesophageal reflux disease (GERD) is still a matter of debate. This study aims to estimate the incidence of GERD and hiatal hernia post LSG and to identify associated risk factors of GERD development.Methods: This is a retrospective cohort study of all patients who underwent LSG surgery at the National Guard medical hospitals (Riyadh and Al-Ahsa) between January 2016 and February 2019. Patients who had undergone LSG, who had a history of GERD or hiatal hernia preoperatively, or who had intraoperative hiatal hernia repair were excluded. Mean, standard deviation, and independent t-test was used for numerical variables, while frequencies, percentages, and chi-square test were used for categorical variables.Results: There were 142 patients included in this study, with the mean age being 39,38 ± 12.68 years, and 64.8% of patients were female. Patients were followed up for 24 months. The incidence of GERD post-operation was 33.% (n=47) and hiatal hernia was 3.5% (n=5). Significantly associated risk factor for post-operative GERD were as follows: age (p=0.026), gender (p=0.038), and hypertension (p=0.014).Conclusion: Incidence of GERD was shown to be relatively high, while hiatal hernia was low; besides age, gender and hypertension, none of the other variables was associated with the development of GERD.

Prevalence and Associated Factors of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy

“…Our findings indicated a significant correlation between the occurrence of GERD symptoms after LSG and factors such as being female, having preoperative hyperlipidemia, and being of older age. These findings are consistent with those of Almutairi et al [ 28 ], who showed a significant correlation between age, sex, and GERD onset postoperatively. In contrast, Althuwaini et al [ 29 ] reported that a high preoperative BMI might be indicative of a lower occurrence of heartburn after LSG.…”

Revision Roux-en-Y Gastric Bypass in the Treatment of Ulcer of the Lower Third of the Esophagus on the Background of Diaphragm Hernia After Laparoscopic Sleeve Gastric Resection

“…A high risk of hiatal hernia development was also found in patients after SG. Therefore, the study confirms that sleeve resection of the stomach can lead to an increase in the risk of developing GERD and hiatal hernia, which should be considered when choosing this technique for treating obesity [19].…”

“…[18] found an association between increasing BMI and the prevalence of GERD, with high BMI being associated with an increased risk of gastroesophageal reflux disease. de Vries et al [19] found that increasing BMI was independently associated with increased inspiratory and expiratory intragastric pressure, which increased the inspiratory gastroesophageal pressure gradient. This study also showed that BMI, intragastric pressure, and gastroesophageal pressure gradient were solid independent predictors of esophageal hiatus hernia, which was the only independent predictor of GERD, and, accordingly, of erosive-ulcerative changes in the gastroesophageal junction.…”

“…It is important to note that reactivity of the esophageal mucosa to refluxate varies greatly from one person to another, and non-physiological transient acid exposure is not always associated with GERD symptoms. This may be important in explaining the variability of outcome statistics for sleeve gastrectomy and GERD [19].…”

Hernia as a Complication of Metabolic Bariatric Surgery

“…In other words, the risk of developing HH after LSG increased over time. More recently, Almutairi et al published a series of 142 post-LSG patients who were followed up for 24 months [81]. Interestingly, the incidence of GERD was 33.1%, whereas that of de novo HH was only 3.5%.…”