Long-term impact of gastropexy on use of acid-reducing medication, second operations for gastroesophageal reflux and subjective reflux symptoms after sleeve gastrectomy

Abstract

Background/Objectives Gastopexy (G) has been introduced as a surgical technique to reduce gastroesophageal reflux disease (GERD) in patients undergoing sleeve gastrectomy (SG). We aimed to determine whether adding G to SG improves use of acid reducing medication (ARM), second operations for GERD, epigastric pain or heartburn after surgery. Subjects/Methods Patients undergoing SG at two Norwegian hospitals were included consecutively from 2011 to 2015. Data was collected prospectively up to 7 years after surgery. GERD was defined by use of ARM on a regular basis and epigastric pain and heartburn by questions derived from the Rome II classification of functional gastrointestinal disorders. G was defined as suturing the gastrocolic ligament to the staple line. Patients undergoing SG only (NG group) were compared to those with additional G (G group) by mixed effect models. Results Of 376 included patients (75% females, mean age 42.6 years and BMI 42.9 kg/m2), 350 (93%) and 232 (62%) were available for evaluation after one and 7 years, respectively. Baseline patient characteristics in the NG (n=235) and G groups (n=141) were similar. In patients without ARM use before surgery, the use increased equally in the NG and G groups up to 7 years after SG. In patients that used ARM at baseline, the proportion decreased equally in the NG and G groups. With a combined endpoint of ARM use and/or second operation for GERD, there was no difference during follow-up between the NG and G groups. With time, the proportion of patients with epigastric pain did not differ between the groups, whereas heartburn was significantly more prominent in the G group. Conclusion In this population of patients undergoing SG, adding G was not associated with reduced use of ARM and/or second operation for uncontrolled GERD, epigastric pain, or heartburn during the first 7 postoperative years.