Impact of Laparoscopic Sleeve Gastrectomy on Gastroesophageal Reflux Disease

Adham R Saad, MD, Lauren Goss, MSPH, Britney Corey, MD, Richard D Stahl, MD, Jayleen Grams, MD. University of Alabama at Birmingham

Introduction: Sleeve gastrectomy is estimated to be the most common bariatric operation performed today. However, the impact of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux remains undetermined with conflicting results in published data. The aim of this study was to examine the impact of LSG on gastroesophageal reflux disease (GERD).

Methods: Retrospective data analyses were performed on all patients undergoing LSG from 2013-2015 at a single institution. The patients were stratified based on the presence or absence of preoperative GERD. Presence of GERD was defined by symptoms, therapy with an anti-reflux medication, or a documented diagnosis of GERD. GERD presence was then determined at last follow up appointment within 24 months. Bivariate frequencies were compared using the Chi-squared test and the relationship between GERD and weight loss were assessed with Student’s t-test.

Results: Of 85 patients, preoperative GERD was present in 54 patients (63.5%). Within this group (preopGERD+), 29 (53.7%) continued to have gastroesophageal reflux postoperatively; while 15 (48.4%) developed postoperative GERD in the group without preoperative GERD (preopGERD-). There were no significant differences in weight, BMI, % weight loss, or ?BMI with GERD outcomes in either of the two groups. Evidence of gastroesophageal reflux on preoperative barium swallow did not predict postoperative reflux. Independent of clinical status, 21 of 35 (60%) patients who had evidence of GERD on preoperative barium swallow had symptomatic GERD after LSG; while, 11 of 27 (41%) patients who did not have evidence of GERD on preoperative barium swallow had postoperative GERD. All patients who developed GERD after bariatric surgery had symptom control on a proton-pump inhibitor, and no patient has required subsequent surgical intervention. There was no statistical difference in follow up intervals between the groups.

Conclusions: Following LSG, gastroesophageal reflux improved in the nearly half of patients who had preoperative GERD. Conversely, almost half of patients without preoperative gastroesophageal reflux developed it postoperatively. Neither weight loss outcomes nor evidence of gastroesophageal reflux on preoperative barium swallow were predictive of postoperative gastroesophageal reflux. Future studies of a larger patient population and longer term follow up are needed.