Alex C Barr, MS, Dr. Jon Gould, Dr. James R Wallace, Dr. Matthew I Goldblatt, Matthew Bosler, Matthew Frelich. Medical College of Wisconsin
Background: Gastroesophageal reflux disease is a common comorbid medical condition of obesity. Two of the most commonly performed bariatric surgical procedures are laparoscopic sleeve gastrectomy and laparoscopic Roux-en Y gastric bypass. The sleeve gastrectomy has been associated with de novo and worsening GERD following surgery in several studies.For this reason, many morbidly obese patients with GERD are counseled to undergo gastric bypass rather than sleeve gastrectomy. Given this practice pattern, we sought to determine acid reduction medication (ARM) utilization in bariatric surgical patients to undergo either a sleeve gastrectomy or gastric bypass prior to surgery and at 1 year postop in a single bariatric surgical program.
Methods: This study was a retrospective review of adult patients who underwent either Roux en-Y gastric bypass or sleeve gastrectomy for morbid obesity at a single institution between January 2011 and July 2015. All procedures were performed by one of three experienced bariatric surgeons. Data was prospectively entered in a clinical database and retrospectively reviewed.
Results: A total of 125 patients met the inclusion criteria. Eighty gastric bypass and 45 sleeve gastrectomy procedures were included. Patient demographics (age, sex, and race), pre-operative BMI and weight did not differ between groups. ARM utilization was more prevalent in gastric bypass patients prior to surgery, although this did not reach statistical significance. At 12 months postop, sleeve patients had a significantly higher rate of overall ARM use, new ARM use, and persistent ARM use than gastric bypass patients (table).
| Laparoscopic Sleeve Gastrectomy | Laparoscopic Roux-en-Y Gastric Bypass | P-value | |
| Pre-op ARM use | 28.1% | 40.3% | 0.07 |
| 12 month ARM use | 51.5% | 17.5% | 0.002 |
| Pre-op ARM, DC @ 12 month | 18% | 68% | 0.005 |
| New ARM @ 12 month | 38.2% | 6.7% | 0.003 |
| Pre-op ARM, no change 12 month | 82% | 31% | 0.005 |
Conclusion: Laparoscopic sleeve gastrectomy is associated with a significantly increased likelihood that acid reduction medications will be necessary for GERD symptom control 12 months following surgery when compared to gastric bypass.This is despite the fact that most patients with GERD are advised to undergo a gastric bypass.Further study on the mechanisms of persistent and de novo GERD in these sleeve gastrectomy patients is needed to minimize this surgical side effect of sleeve gastrectomy.