Does Helicobacter Pylori Increase the Risk of Adverse Outcome After Laparoscopic Sleeve Gastrectomy

Ameer Gomberawalla, MD, Amy Thomas, RN, Insiyah Nomanbhoy, MS, Rami Lutfi, MD, FACS. Chicago Institute of Advanced Bariatrics.

INTRODUCTION: Helicobacter pylori is a common gastrointestinal pathogen that was found to affect outcomes of many foregut operations. In bariatric surgery, H. pylori was thought by many to negatively affect outcome. Our study aims to evaluate the impact of H pylori on short term outcomes after laparoscopic sleeve gastrectomy (LSG).

METHODS AND PROCEDURES: We analyzed 280 consecutive patients who underwent LSG by a single surgeon over 48 months. All gastric specimens were tested for the presence of H. pylori, and patients with negative pathology were compared to those with positive testing. Routine preoperative testing was not performed. A subset of 252 consecutive sleeves was analyzed after implementation of a one day discharge protocol to investigate whether H pylori status impacted length of stay (LOS). We compared LOS, 30 day complications, readmissions and emergency room visits (up to 1 year), as well as excess weight loss at 1 year (EWL1). Independent t-test and Fisher exact probability tests were done to identify significant outcomes.

RESULTS: Twenty one (7.5%) of the 280 patients tested positive for H. pylori on post-operative pathology. There were three major complications potentially related to H. pylori requiring intervention (1 leak, and 2 strictures), all in the H. Pylori negative group. The average length of stay was longer for the H. pylori positive group compared to the negative group (1.85 vs 1.45, p=0.02). The most common reason for prolonged stay was severe nausea. Those in the H. pylori positive group (23%) were more likely to require an ER visit or hospital admission related to their procedure when compared to the H. pylori negative group (6.42%) (OR=3.93, 95% CI =1.28-12.04, p< 0.05). EWL1 was equivalent for both groups, 71% in the H. pylori negative group and 72% in the H. pylori positive group (p=0.44).

CONCLUSION: The presence of H. pylori does not increase the risk of major complications after sleeve gastrectomy and does not affect weight loss. However, It may be related to longer hospitalization and higher readmission rates.

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