Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique

Jorge Daes, Manuel E Jimenez, Nadin Said, Juan C Daza, Rodolfo Dennis, Jorge Daes, Manuel E Jimenez, Nadin Said, Juan C Daza, Rodolfo Dennis

Abstract

Background: Bariatric surgery is the most effective treatment for gastro-esophageal reflux disease (GERD) in obese patients, with the Roux-en-Y gastric bypass being the technique preferred by many surgeons. Published data reporting the results of laparoscopic sleeve gastrectomy (LSG) in patients with GERD are contradictory. In a previous observational study, we found that relative narrowing of the distal sleeve, hiatal hernia (HH), and dilation of the fundus predispose to GERD after LSG. In this study, we evaluated the effects of standardization of our LSG technique on the incidence of postoperative symptoms of GERD.

Methods: This was a concurrent cohort study. Patients who underwent bariatric surgery at our center were followed prospectively. LSG was performed in all patients in this series.

Results: A total of 234 patients underwent surgery. There were no cases of death, fistula, or conversion to open surgery. All 134 patients who completed 6-12 months of postoperative follow-up were evaluated. Excess weight loss at 1 year was 73.5%. In the study group, 66 patients (49.2%) were diagnosed with GERD preoperatively, and HH was detected in 34 patients (25.3%) intraoperatively. HH was treated by reduction in three patients, anterior repair in 28, and posterior repair in three. Only two patients (1.5%) had symptoms of GERD at 6-12 months postoperatively.

Conclusions: Our results confirm that careful attention to surgical technique can result in significantly reduced occurrence of symptoms of GERD up to 12 months postoperatively, compared with previous reports of LSG in the literature.

References

    1. Schneider JH, Küper M, Königsrainer A, et al. Lower esophageal sphincter relaxation in morbid obesity. Obes Surg. 2009;19(5):595–600. doi: 10.1007/s11695-009-9809-7.
    1. Soricelli E, Casella G, Rizzello M, et al. Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy. Obes Surg. 2010;20(8):1149–1153. doi: 10.1007/s11695-009-0056-8.
    1. Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15(9):986–989. doi: 10.1007/s004640000392.
    1. Perez AR, Moncure AC, Rattner DW. Obesity is a major cause of failure for both abdominal and transthoracic antireflux operations. Gastroenterology. 1999;116:A1343.
    1. Fraser J, Watson DI, O’Boyle CJ, et al. Obesity and its effect on outcome of laparoscopic Nissen fundoplication. Dis Esoph. 2001;14(1):50–53. doi: 10.1111/j.1442-2050.2001.00157.x.
    1. Braghetto I, Csendes A, Korn O, et al. Gastroesophageal reflux disease after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):148–153. doi: 10.1097/SLE.0b013e3181e354bc.
    1. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–863. doi: 10.1007/s00464-005-0134-5.
    1. Hamoui N, Anthone GJ, Kaufman HS, et al. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16(11):1445–1449. doi: 10.1381/096089206778870157.
    1. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–565. doi: 10.1007/s11695-007-9288-7.
    1. Gagner M, Deitel M, Kalberer TL, et al. The second international consensus summit for sleeve gastrectomy. Surg Obes Relat Dis. 2009;5:476–485. doi: 10.1016/j.soard.2009.06.001.
    1. Deitel M, Gagner M, Erickson A, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–759. doi: 10.1016/j.soard.2011.07.017.
    1. Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7(4):510–515. doi: 10.1016/j.soard.2010.09.011.
    1. Lazoura O, Zacharoulis D, Triantafyllidis G, et al. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg. 2010;21(3):295–299. doi: 10.1007/s11695-010-0339-0.
    1. Keidar A, Appelbaum L, Schweiger C, et al. Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg. 2010;20(2):140–147. doi: 10.1007/s11695-009-0032-3.
    1. Prachand V, Alverdy JC. Gastroesophageal reflux disease and severe obesity: fundoplication or bariatric surgery? World J Gastroenterol. 2010;16(30):3757–3761. doi: 10.3748/wjg.v16.i30.3757.
    1. Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20(3):357–362. doi: 10.1007/s11695-009-0040-3.
    1. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17(1):57–62. doi: 10.1007/s11695-007-9006-5.
    1. Soricelli E, Basso N, Genco A, et al. Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery. Surg Endosc. 2009;23:2499–2509. doi: 10.1007/s00464-009-0425-3.
    1. Frantzides CT, Madan AK, Carlson MA, et al. A prospective, randomized trial of laparoscopic polytetraflouroethylene (PTFE) patch repair vs. simple cruroplasty for large hiatal hernia. Arch Surg. 2002;137(6):649–653. doi: 10.1001/archsurg.137.6.649.
    1. Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. 2005;140(1):40–48. doi: 10.1001/archsurg.140.1.40.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren