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The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity

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Abstract

Introduction

The impact of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) has not been widely quantified, and the data in the literature remain controversial.

Materials and Methods

Candidates for LSG underwent barium swallow, esophageal manometry, ambulatory 24-h esophageal pH monitoring (APM), and gastric emptying scintigraphy before and after surgery (1 and 18 months). Symptoms were evaluated using a gastroesophageal reflux disease questionnaire (GERDq). Esophagogastroduodenoscopy was performed preoperatively in all patients and at 18 months postoperatively in patients who had suffered from preoperative esophagitis.

Results

Fifty-two patients were included in the study (64.4% women and 34.6% men) with a median age of 46 years (25–63 years) and BMI of 45.0 ± 5.6 kg/m2. The follow-up rates at 1 and 18 months were 82.7% and 80.8%. At 18 months, the percentage of weight loss (%TWL) was 33.6 ± 10.4% and the percentage of excess BMI loss (%EBMIL) was 77.6 ± 25%. Postoperatively, a significant increase in accelerated gastric emptying and impaired esophageal body motility occurred at 1 and 18 months. A significant worsening of all the values obtained at both 1 and 18 months postoperatively becomes evident when comparing the results of the APM. After surgery, 76.4% of patients had developed “de novo” GERD at 1 month and 41% at 18 months. No improvement was found in patients with symptomatic GERD.

Conclusion

Based on the results of this study, LSG led to a considerable rate of postoperative “de novo” GERD. In addition, no improvement was found in patients with symptomatic GERD.

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Authors and Affiliations

  1. Department of General Surgery, Hospital Arnau de Vilanova, Valencia, Spain

    Cristina Sancho Moya

  2. Department of Esophagogastric Surgery, Hospital Universitari I Politècnic La Fe, Valencia, Spain

    Marcos Bruna Esteban

  3. Department of Digestive, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain

    Javier Sempere García-Argüelles, Luis Ferrer Barceló, Ana Monzó Gallego & Beatriz Mirabet Sáez

  4. Department of Esophagogastric and Obesity Surgery, Consorcio Hospital General Universitario de Valencia (CHGUV), Valencia, Spain

    Claudia Mulas Fernández, Pilar Albors Bagá, Antonio Vázquez Prado & Miguel Oviedo Bravo

  5. Department of Hepatobiliary, Pancreatic Surgery and Transplantation, Hospital Universitari I Politècnic La Fe, Valencia, Spain

    Eva Montalvá Orón

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  1. Cristina Sancho Moya
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Correspondence to Cristina Sancho Moya.

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Key Points

• LSG led to a considerable rate of postoperative “de novo” GERD.

• The clearance of acid in the distal esophagus is decreased after sleeve gastrectomy.

• Patients with symptomatic GERD do not experience an improvement after LSG.

• Preoperative study of GERD symptomatology and EGD seems appropriate.

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Sancho Moya, C., Bruna Esteban, M., Sempere García-Argüelles, J. et al. The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity. OBES SURG 32, 615–624 (2022). https://doi.org/10.1007/s11695-021-05808-w

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  • DOI: https://doi.org/10.1007/s11695-021-05808-w

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