Tarik D Madni, MD, Jonathan Imran, MD, Erica Hodgman, MD, Audra Clark, MD, Daniel J Scott, MD, Tjasa Hranjec, MS, MD, Sara A Hennessy, MD. University Of Texas Southwestern Medical Center
Introduction: In recent years, laparoscopic sleeve gastrectomy (LSG) has gained popularity as a bariatric restrictive procedure to aid in the reduction of weight and its associated comorbidities. Currently, it is highly debated in the literature as to the effects of LSG on gastroesophageal reflux disease (GERD). Specifically, pre-operative GERD, intraoperative variations in boogie size, and distance stapled from pylorus have been correlated to post-operative GERD development. We aim to further identify pre and peri-operative risk factors for GERD following LSG.
Methods: A retrospective review was performed of all patients who underwent a LSG at a single institution between 07/2014 and 12/2015. The primary outcome of interest was post-operative GERD at 6 months. Stomach length was defined as the length of the stomach on pathology specimen. Patients with and without postoperative GERD were compared on pre-operative and intraoperative factors by univariate analysis using Wilcoxon rank sum, Chi-square, and Fisher’s exact tests where appropriate. A multivariate logistic regression was performed to identify independent predictors of postoperative GERD after LSG. All variables were identified a priori.
Results: A total of 173 LSG (18% males, 82% females) performed by 5 surgeons were identified. GERD at 6 months was reported in 77 (44.5%) of patients. There was no difference in comorbidities in patients with and without postoperative GERD. Patients with postoperative GERD had significantly higher incidence of pre-operative GERD (60% vs 36%, p = 0.003). There was no significant difference between the two groups in bougie size (36.9Fr±3.9 vs 36.9Fr±4.1, p=0.99) or distance stapled from the pylorus (6.1cm±1.2 vs. 6.3cm±1.2, p=0.43). In the multivariate analysis (Table 1) preoperative GERD (OR 2.839; 95% CI 1.452-5.549) and stomach length (OR 2.428; 95% CI 1.167-5.049) were found to be the only predictors of postoperative GERD.
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Discussion: Approximately 45% of patients are treated for GERD after LSG. The presence of preoperative GERD and long stomach length are associated with postoperative GERD. No significant differences in GERD were noted with intraoperative technique. Further studies on stomach anatomy and size are required to understand the effect of gastric pouch length on post-operative GERD development.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79406
Program Number: P479
Presentation Session: Poster (Non CME)
Presentation Type: Poster
