• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Symptomatic Reflux after Bariatric Surgery: What can we expect?

Abel E Bello, MD, Leena Khaitan, MD. University Hospitals Case Surgery

INTRODUCTION:

Restrictive bariatric procedures such as Sleeve Gastrectomy (SG), Adjustable Gastric Banding (LGB) and Vertical Band Gastroplasty (VBG) have been associated with worsening reflux symptoms in patients with and without pre-existing disease, but data is conflicting. Roux-En-Y Gastric Bypass (RYGB) has been the procedure of choice for treating gastroesophageal reflux disease (GERD) in the morbidly obese, and also a revision option for patients with GERD after weight loss surgery (WLS). There is no clear consensus on the best treatment option for bariatric patients that develop symptomatic GERD. We present a series of bariatric patients with post-operative symptomatic GERD and how manometry findings helped to guide treatment.

METHODS:

A retrospective review was performed from 2006-2014 of all consecutive patients with primary complaint of GERD following WLS. Patients with upper endoscopy, esophagogram and manometry were included for analysis. Data on demographics, preoperative and postoperative symptoms, weight loss, and procedure details were collected. Previous surgeries were performed at outside hospitals. Data were kept in secure database. Statistical analysis performed using SPSSV22.

RESULTS:

Nine patients met the inclusion criteria. All patients had prior restrictive WLS as either initial or secondary procedure. Four patients had 1 prior foregut procedure. Initial WLS were 5 SG, 2 VBG and 2 LGB. Six patients had dysphagia. Mean BMI at presentation was 43.13±3.86. Mean Follow up 50.66±32.35 months. Excess Weight Loss (EWL) at presentation from WLS (Mean 37.55±10.07%) which improved after revision (Mean 47.21±10.34%). Esophageal peristalsis was normal in 8/9 patients. 7 patients had revisional surgery. Of those with prior SG, 1 had hiatal hernia repair and 3 had removal of fundus with conversion to RYGBP. The remaining 1 SG patient on manometry has short intraabdominal LES, transient relaxation with otherwise normal LESP, bolus transit and peristalsis and is awaiting HH repair. Of the 2 Prior VBG, 1 had conversion to RYGBP and 1 not wanting surgery. All RYGB conversions had high-pressure zone distal to LES noted on high-resolution manometry (HRM). One patient had LGB removal without conversion. All had resolution of symptoms after revisional surgery and procedures were completed laparoscopically. Pre-existing GERD and previous PPI use was associated with post-op dysphagia after WLS (p=0.018), but not with LES pressure abnormalities or esophageal dysmotility (p=0.59 and 0.35 respectively). Bolus transit was comparable between all patients. Not all patients required conversion to RYGBP to treat the reflux and dysphagia.

CONCLUSION:

Treatments for reflux after WLS should be tailored to the cause of the problem. A high pressure zone distal to the LES seen on HRM is helpful in identifying those patients requiring conversion to RYGBP for revision. Others may just have HH repair if LES pressure normal. Thus, manometry can help to guide the surgeon in choosing the best treatment option for patients with GERD after WLS. Revisional surgery in these patients also significantly improves weight loss.

4,517

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons