Federico Moser, MD1, German Viscido, MD1, Franco Signorini, MD1, Luciano Navarro, MD1, Veronica Gorodner, MD2, Lucio Obeide, MD1. 1Hospital Privado de Cordoba, 2Programa de Unidades Bariatricas
Introduction: laparoscopic sleeve gastrectomy (LSG) has shown excellent results in terms of weight loss and resolution of comorbidities for the treatment of obesity. In spite of that, the prevalence of gastroesophageal reflux disease (GERD) like symptoms and erosive esophagitis (EE) during the postoperative period is a controversial matter. Our objective was to evaluate the presence of GERD like symptoms, EE, and hiatal hernia (HH) in obese patients who underwent LSG at 1-year follow up.
Methods and procedures: a retrospective review from prospective collected data was performed. Obese patients undergoing LSG were studied. Anthropometrics, comorbidities, pre and postoperative esophagogastroduodenoscopy (EGD) and postoperative morbidity were analyzed. Presence/absence of pre and postoperative symptoms (heartburn, regurgitation, epigastric pain) were also assessed using a questionnaire.
Results: between June 2012 and July 2014, 285 patients underwent LSG at our Institution; 109 met the inclusion criteria for this study. Mean follow up was 14±7 months. Mean age 40±9 years, 66% of patients were female. Initial BMI decreased from 47.8± 16 kg/m2 to 29.3± 6 kg/m2; % excess weight loss (%EWL) was 64±9.4. Resolution of comorbidities: diabetes 70%, hypertension 53%, and sleep apnea 87%; The prevalence of EE increased significantly after LSG (20.1% vs. 33.9%; p<0.05). The same phenomenon was found with HH (22% vs. 34.8%; p<0.05). All EE found during the preoperative evaluation were Grade A (Los Angeles classification). Postoperatively, 26 pts. (74%) had Grade A esophagitis, 7 (20%) Grade B and 2 (6%) Grade C; GERD like symptoms also increased although the difference was not statistically significant (36 pts=33% vs. 48 pts=44%) (p=NS); 80% of them described their symptoms as mild and sporadic and were relieved by taking proton pump inhibitors (PPI’s). There was a strong correlation between symptoms and the presence of EE (p=<0.05); for the 48 symtomatic patients after LSG, correlation was as follows: 30 (62.5%) had EE on EGD, 10 pts. (21%) had HH, and 8 pts. (16.5%) had no correlation. De novo EE was present in 25% of patients, HH in 16% and symptoms in 35%. Postoperative morbidity was 3.5% (four postoperative bleeding, one of them requiring percutaneous drainage). There was no mortality in these series.
Conclusion: the prevalence of EE, HH and GERD like symptoms was increased after surgery. Postoperative EE was non severe in the majority of patients and symptoms were mild, sporadic and were relieved by PPI’s. There was a strong correlation between symptoms and presence of EE.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79774
Program Number: S129
Presentation Session: Bariatric surgery – Sleeves, Conversions and More
Presentation Type: Podium