The impact of sleeve gastrectomy on resolution of reflux symptoms in the morbidly obese

Ajay N Ranade, MD, Jeremy P Parcells, MD, Corrigan L McBride, MD, Vishal M Kothari, MD, Matthew R Goede, MD, Dmitry Oleynikov, MD

University of Nebraska Medical Center

Introduction:
Sleeve gastrectomy is becoming a more popular bariatric operation, but certain long term outcomes are still being established. One of these issues is gastroesophageal reflux disease (GERD). Outcomes have been variable between institutions, without there being a consensus on management of obese patients with reflux and sleeve gastrectomy. We looked at our institution’s sleeve gastrectomy patients to determine outcomes with regards to GERD symptomatology.

Methods:
Over an eight year period from April 2004 to April 2012, 75 patients underwent a sleeve gastrectomy at our institution and were placed into a prospective database. Data included BMI, smoking history, presence of pre-operative reflux, post-operative course and follow-up. Each post-operative visit included a questionnaire filled out by patients that assessed reflux symptoms.

Results:
A total of 75 patients were evaluated. Preoperatively, 36 (48%) of these patients had reflux. Overall, eleven patients (14.7%) had post-operative reflux; of those eleven, nine had pre-operative reflux. Patients with pre-operative reflux were more likely to experience reflux post-operatively than those without preoperative reflux (p=0.02). Overall, a significant proportion (75%) of the group with symptomatic pre-operative reflux experienced resolution of their symptoms. Two of thirty-nine patients (5.1%) with no reflux history developed reflux post-operatively.

Conclusion:
While we found that sleeve gastrectomy leads to resolution of reflux symptoms in the majority of patients with preoperative reflux, there was a subset of patients who did not experience symptom resolution. Furthermore, a minority of patients without preoperative reflux developed reflux post-operatively. Currently, the most definitive management of post-sleeve gastrectomy reflux is conversion to a Roux-en-Y gastric bypass. Identifying patients with increased risk of postoperative reflux may mean they are not candidates for a sleeve gastrectomy, or that they may require modification of their sleeve gastrectomy to include an anti-reflux mechanism.

Session: Poster Presentation

Program Number: P452