De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux

Introduction Obesity is associated with a higher prevalence of various comorbidities including gastroesophageal reflux disease. It is yet still unclear whether LSG exacerbates or alleviates GERD symptoms. Available date in the literature on LSG influence on GERD are contradictory. Material and methods Systematic review of literature comparing GERD in sleeve gastrectomy versus sleeve gastrectomy with concomtitant hiatal repair. The review was conducted in January 2021 in accordance to PRISMA guidelines. Inclusion criteria involved reporting GERD and comparison of above mentioned techniques. Primary outcome of interest were alleviation of GERD and “de-novo” GERD symptoms. Secondary outcomes were operative time and morbidity. Results Initial search yielded 831 records. After the review and full-text screening 5 studies were included in the analysis. There were no differences in terms of GERD outcomes, p=0.74 for alleviation, p=0.77 for new symptoms. Concomitant hiatal hernia repair significantly prolongs sleeve gastrectomy by 38 mins. Conclusion There are no differences in GERD between hiatal hernia repair during sleeve gastrectomy in comparison to sleeve gastrectomy alone. More high-quality studies are required to fully evaluate this subject.

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PS01.048: LAPAROSCOPIC ANTIREFLUX SURGERY IN MORBIDLY OBESE PATIENTS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.048 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 63-63

Author(s):

Marcin Migaczewski ◽

Mateusz Rubinkiewicz ◽

Michał Pędziwiatr ◽

Piotr Major ◽

Jadwiga Dworak ◽

...

Keyword(s):

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

De Novo ◽

Morbidly Obese ◽

Obese Patients ◽

Gerd Symptoms ◽

Crural Repair

Abstract Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proved to be effective bariatric procedure for the treatment of morbidly obese patients with gastroesophageal reflux disease (GERD). In contrast, the indication for laparoscopic sleeve gastrectomy (LSG) in these group of patients is still not clear. LSG with simultaneous crural repair it can be a new, safe and effective therapautic approach. Methods A total of 60 obese patients with GERD operated on in 2016–2018 were included in the study. 20 patients were qualified for LRYBG. In the rest LSG was performed, of which half with simultaneous crural repair. Results GERD symptoms complete control was observed in 18/20 (90%) patients after LRYGB and 17/20 (85%) after LSG with simultaneous crural repair. The same effect occurred only in 8/20 patients direct after simple LSG. ‘De novo’ GERD symptoms developed in 10% of the patients undergoing alone LSG during 12 months follow up. Conclusion Laparoscopic Roux-en-Y gastric bypass (LRYGB) is still effective bariatric procedure for the treatment of morbidly obese patients with gastroesophageal reflux disease (GERD). Doubts remain in the situation of young patients without diabetes. If we additionally deal with a large hiatal hernia, the qualification for LRYGB remains debatable. In this situation, it is worth considering LSG. Simple sleeve gastrectomy not only does not guarantee a good anti-reflux effect, but it can also produce de-novo GERD. Laparoscopic simultanous crurolasty in the time of LSG, represents a valuable option for the treatment of morbid obesity with gastroesophageal reflux disease Disclosure All authors have declared no conflicts of interest.

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