Gastroesophageal Reflux Symptoms after Laparoscopic Vertical Sleeve Gastrectomy for Morbid Obesity. the Importance of Preoperative Identification of Hiatal Hernia

Iswanto Sucandy, MD, Gintaras Antanavicius, MD, FACS, Fernando Bonanni, MD, FACS

Abington Memorial Hospital, Department of Surgery

Background: Gastroesophageal reflux disease (GERD) is prevalent in morbidly obese patients, and its severity appears to correlate with body mass index (BMI). It is established that Roux-en-Y gastric bypass (RYGB) produces marked clinical improvements in reflux symptoms. However, previously published reports have correlated vertical sleeve gastrectomy with persistence or worsening of reflux symptoms, possibly related to division of the gastroesophageal muscle fibers and the presence of high pressure zone in the proximal gastric sleeve. In this study, we investigated the status of reflux symptoms after laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients.

Methods: A prospectively maintained database of consecutive patients who underwent LSG from February 2008 to May 2011 was reviewed. Preoperative evaluation included esophagogastroduodenoscopy (EGD). Special attention was paid to identify the presence of hiatal hernia, which is uniformly repaired after anatomic confirmation intraoperatively. All patients were interviewed pre- and postoperatively to evaluate their reflux symptoms.

Results: A total of 131 patients, 98 women and 33 men, were included in this study. The mean age and BMI were 49.4 years (range: 17-79) and 48.9 kg/m2 (range: 34-84), respectively. Prior to LSG, reflux symptoms were reported in 67 patients (51%) . The average length of procedure including hiatal hernia repair when found was 106 minutes (range: 48-212). There were no major intra- and postoperative complications. Following LSG, 32 (47.7%) of the patients with reflux symptoms experienced complete resolution of their symptoms, 20 (29.9%) reported improvement of symptoms, and 12 (22.2%) reported unchanged or persistent symptoms. Two patients developed new-onset reflux symptoms postoperatively, which were mild and fully controlled with anti-acid medication. No patient required conversion to RYGB or duodenal switch due to severe reflux symptoms. Follow-up data were available in 60% of patients at 1 year. The average excess body weight loss at 1,3,6,9,12, and 18 months was 19.3%, 31.2%, 44.5%, 50.2%, 57.1%, and 63.6%, respectively. No mortality occurred in this series.

Conclusions: Laparoscopic VSG results in resolution or improvement of reflux symptoms in large number of patients. Proper patient selection and complete preoperative evaluation, which includes identification of hiatal hernia, are crucial to achieve optimal patients outcomes. Further studies with objective measurements of reflux symptoms are needed.

Session: Poster Presentation

Program Number: P195

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