The effect of laparoscopic sleeve gastrectomy on the antireflux mechanism: can it be minimized?

Kleidi, Eleftheria; Theodorou, Dimitrios; Albanopoulos, Konstantinos; Menenakos, Evangelos; Karvelis, Michail A.; Papailiou, Joanna; Stamou, Konstantinos M.; Zografos, Georgios; Katsaragakis, Stylianos; Leandros, Emmanuel

doi:10.1007/s00464-013-3083-4

Cited by 51 publications

(54 citation statements)

References 33 publications

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“…Most studies defined GERD based on proton pump inhibitors (PPIs) use, symptoms evaluation, and presence of esophagitis. Only few studies objectively analyzed patients by esophageal manometry and 24-pH monitoring[15,20,29,33,34,38,40,43,44]. …”

Section: Gerd and Lsg: The Evidencementioning

confidence: 99%

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

Rebecchi

Allaix

Patti

et al. 2017

WJG

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Laparoscopic sleeve gastrectomy (LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease (GERD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GERD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h pH monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GERD, and occurrence of de novo GERD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GERD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve (both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Roux-en-Y gastric bypass are the available options for the management of GERD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GERD and hypotensive LES: the LINX® Reflux Management System procedure and the Stretta® procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of pH monitoring data and the new insights in the association between sleeve morphology and GERD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GERD, as recently stated in the 5th International Consensus Conference on sleeve gastrectomy.

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Section: Gerd and Lsg: The Evidencementioning

confidence: 99%

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

Rebecchi

Allaix

Patti

et al. 2017

WJG

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“…According to some authors, even a small amount of gastric fundus may have a protective role against GERD, as its complete resection could damage the sling fibers at His angle [28], causing a hypotonic LES. On the contrary, Toro et al [29] demonstrated a major recurrence of GERD symptoms in patients with upper pouch.…”

Section: Discussionmentioning

confidence: 99%

Relationship between gastric pouch and weight loss after laparoscopic sleeve gastrectomy

et al. 2015

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“…In others, however, there is no dilation of the proximal gastric pouch where the weakening of the lower esophageal sphincter or the TLESR is the only reason for the development of their de novo reflux [5], [10], [11]. The presence or development of a hiatal hernia may be a contributing factor as well.…”

Section: Discussionmentioning

confidence: 99%

“…Management of this problem is usually medical with proton pump inhibitors (PPI). After medical management, conversion to RYGB is usually recommended for severe reflux that is uncontrolled medically [5]. With our experience in placing the LINX ® system for managing reflux in non-obese patients, we decided to offer this procedure to one of the patients who had been suffering from severe uncontrolled reflux after sleeve gastrectomy.…”

Section: Introductionmentioning

confidence: 99%