William J Haberlin, MD, Dimitrios Stefanidis, MD, PhD, Amanda L Walters, MS, Keith Gersin, MD, Timothy Kuwada, MD. Section of Bariatric Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte North Carolina.
Introduction: Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular and effective bariatric procedure. However, it’s effectiveness in treating GERD has been questioned. Some studies have even demonstrated worsening GERD symptoms. Our objective was to investigate the effect of LSG on GERD symptoms (GS) in our patient population.
Methods: Retrospective review of prospectively collected data of a single surgeon’s, LSG series (excluding revisions) between 2008 and 2013. Routine PPI’s were not used postoperatively. GERD symptoms and medications were recorded preoperatively and postoperatively at 3, 6, and 12 months. Symptoms were categorized as either resolved (asymptomatic off medications), improved, or worse. Patient demographics presence and repair of hiatal hernia, and %EWL were also recorded. All patients with at minimum of 3 months follow up were included.
Results: 226 LSG met inclusion criteria. Follow up at 3,6 and 12 months was 71%, 61% and 50% respectively. Demographics: mean age 45.0±10.1, gender: 78.8% female, preoperative BMI 43.8±5.6. LOS: 2.2±0.7 days. The mean OR time was 74.7±30.2 minutes, 21% had a combined hiatal hernia repair.. There were no leaks or perioperative reoperations. 44.6 % patients had preop GS. At 3, 6 and 12 months after surgery 72%, 82% and 82% respectively had improvement or resolution of their GS. At 12 months follow up 2 patients had developed new GS (asymptomatic preop) and 6 (8.2%) had worsening of their preop GS. There were no differences at any time point for operative time, EBL, LOS and percent excess weight loss associated with improvement in GERD (all p>0.05). At 3 months those with improved reflux were more like to undergo hiatal hernia repair (29.2% vs 14.0%; p=0.017. However, these were not significantly different at 6 and 12 months.
Conclusion: The vast majority (82%) of patients in our study with pre-existing GERD symptoms had improvement or resolution of their GS after LSG. Only 2.7% of asymptomatic patients developed GS after LSG. Our findings indicate that LSG rarely leads to new onset or worsening of GERD based on patient reported symptoms . Further studies are required to determine the endoscopic and quantitate (pH study) changes in GERD after LSG.