The Hill’s Classification Is Useful to Predict the Development of Postoperative Gastroesophageal Reflux Disease and Erosive Esophagitis After Laparoscopic Sleeve Gastrectomy

Abstract

Background:Laparoscopic sleeve gastrectomy (LSG) is one of the commonest bariatric procedures. However, it is associated with postoperative gastroesophageal re ux disease (GERD) and erosive esophagitis (EE). This study aims to assess the impact of various preoperative clinical and endoscopic characteristics on the development of postoperative GERD and EE. Methods:A single institution retrospective cohort study involving all patients who underwent LSG. A univariate and multivariate analysis was performed to identify preoperative parameters that were signi cantly associated with the development of postoperative GERD and EE, at up to 1-year follow-up. Results:At up to 1-year follow-up, out of 127 patients, only preoperative endoscopic presence of a hiatal hernia noted on axial length (p=0.024), and the Hill's classi cation of the gastroesophageal junction (p<0.001), were signi cantly associated with the development of postoperative GERD. Similarly, at 1-year follow-up endoscopy, the presence of a hiatal hernia (p=0.041) and the Hill's classi cation (p=0.001) were associated with postoperative EE. On the multivariate analysis, compared to patients with a Hill's I ap valve, Hill's II patients were more likely to develop postoperative GERD (OR 7.13, 95% CI: 1.69-29.98, p=0.007), and Hill's III patients were more likely to develop postoperative GERD (OR 20.84, p<0.001) and EE (OR 34.49, 95% CI: 1.08-1105.36, p=0.045). All patients with Hill's IV developed postoperative GERD and EE in this study. Conclusion:Postoperative GERD and EE remains an important limitation following LSG. Proper preoperative assessment using the Hill's classi cation can help to accurately predict patients at risk of postoperative GERD and EE.