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Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results.
Surg Endosc. 2015 Jul; 29(7):1760-8.SE

Abstract

INTRODUCTION

There is no question that Roux-en-Y gastric bypass (RYGB) is the best treatment option for obesity combined with GERD. However, the influence of laparoscopic sleeve gastrectomy (LSG) on this disease remains controversial. It has been said that LSG could induce de novo GERD or worsen it. The aim of our study was to evaluate the influence of LSG on GERD.

METHODS AND PROCEDURES

Candidates for LSG underwent esophageal manometry (EM) and 24 h pH monitoring before and 1 year after LSG. Symptoms were evaluated using a validated score. Esophageal function test (EFT's) results and symptoms were compared before and after surgery.

RESULTS

Between 4/12 and 9/13, 118 patients underwent LSG. EFT's were performed in 92 (78%) of them preoperatively. From the 19 patients 1 year out of surgery, 14 (73%) completed their EFT's postop. There were 13 women, age 42 ± 12 years, BMI 40 ± 6 kg/m(2). At 14 months, % excess weight loss (EWL) was 74. EM: lower esophageal sphincter (LES) length increased from 2.7 to 3.2 cm (p = NS), and LES pressure decreased from 17.1 to 12.4 mmHg (p ≤ 0.05). Preoperatively, LES was normotensive in 13 (93%) patients; postoperatively, LES was normal in 10 (71%) (p = NS). DeMeester score increased from 12.6 to 28.4 (p ≤ 0.05). Postoperatively, 5 (36%) patients had de novo GERD, in 3 (21%) GERD worsened, 1 (7%) remained with GERD and 5 (36%) remained without reflux. No difference was seen between preop. and postop. symptoms score.

CONCLUSION

Our preliminary data showed that after LSG LESP significantly decreased, and the DeMeester score significantly increased. Although LSG results appear appealing in terms of weight loss, patients should be warned that they might need proton pump inhibitors after the operation. Surgeons should probably lower their threshold for indicating RYGB in patients with known preoperative GERD.

Authors+Show Affiliations

Programa de Unidades Bariátricas, Buenos Aires, Argentina, vgorodner_72@yahoo.com.ar.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25303918

Citation

Gorodner, Verónica, et al. "Does Laparoscopic Sleeve Gastrectomy Have Any Influence On Gastroesophageal Reflux Disease? Preliminary Results." Surgical Endoscopy, vol. 29, no. 7, 2015, pp. 1760-8.
Gorodner V, Buxhoeveden R, Clemente G, et al. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surg Endosc. 2015;29(7):1760-8.
Gorodner, V., Buxhoeveden, R., Clemente, G., Solé, L., Caro, L., & Grigaites, A. (2015). Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surgical Endoscopy, 29(7), 1760-8. https://doi.org/10.1007/s00464-014-3902-2
Gorodner V, et al. Does Laparoscopic Sleeve Gastrectomy Have Any Influence On Gastroesophageal Reflux Disease? Preliminary Results. Surg Endosc. 2015;29(7):1760-8. PubMed PMID: 25303918.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. AU - Gorodner,Verónica, AU - Buxhoeveden,Rudolf, AU - Clemente,Gastón, AU - Solé,Laura, AU - Caro,Luis, AU - Grigaites,Alejandro, Y1 - 2014/10/11/ PY - 2014/04/04/received PY - 2014/09/04/accepted PY - 2014/10/12/entrez PY - 2014/10/12/pubmed PY - 2016/3/11/medline SP - 1760 EP - 8 JF - Surgical endoscopy JO - Surg Endosc VL - 29 IS - 7 N2 - INTRODUCTION: There is no question that Roux-en-Y gastric bypass (RYGB) is the best treatment option for obesity combined with GERD. However, the influence of laparoscopic sleeve gastrectomy (LSG) on this disease remains controversial. It has been said that LSG could induce de novo GERD or worsen it. The aim of our study was to evaluate the influence of LSG on GERD. METHODS AND PROCEDURES: Candidates for LSG underwent esophageal manometry (EM) and 24 h pH monitoring before and 1 year after LSG. Symptoms were evaluated using a validated score. Esophageal function test (EFT's) results and symptoms were compared before and after surgery. RESULTS: Between 4/12 and 9/13, 118 patients underwent LSG. EFT's were performed in 92 (78%) of them preoperatively. From the 19 patients 1 year out of surgery, 14 (73%) completed their EFT's postop. There were 13 women, age 42 ± 12 years, BMI 40 ± 6 kg/m(2). At 14 months, % excess weight loss (EWL) was 74. EM: lower esophageal sphincter (LES) length increased from 2.7 to 3.2 cm (p = NS), and LES pressure decreased from 17.1 to 12.4 mmHg (p ≤ 0.05). Preoperatively, LES was normotensive in 13 (93%) patients; postoperatively, LES was normal in 10 (71%) (p = NS). DeMeester score increased from 12.6 to 28.4 (p ≤ 0.05). Postoperatively, 5 (36%) patients had de novo GERD, in 3 (21%) GERD worsened, 1 (7%) remained with GERD and 5 (36%) remained without reflux. No difference was seen between preop. and postop. symptoms score. CONCLUSION: Our preliminary data showed that after LSG LESP significantly decreased, and the DeMeester score significantly increased. Although LSG results appear appealing in terms of weight loss, patients should be warned that they might need proton pump inhibitors after the operation. Surgeons should probably lower their threshold for indicating RYGB in patients with known preoperative GERD. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/25303918/Does_laparoscopic_sleeve_gastrectomy_have_any_influence_on_gastroesophageal_reflux_disease_Preliminary_results_ L2 - https://dx.doi.org/10.1007/s00464-014-3902-2 DB - PRIME DP - Unbound Medicine ER -