Open Access
35- https://doi.org/10.4103/1947-2714.157624
Gastroesophageal Reflux Symptoms After Laparoscopic Sleeve Gastrectomy for Morbid Obesity. The Importance of Preoperative Evaluation and Selection
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Background:Gastroesophageal reflux disease (GERD) is prevalent in morbidly obese patients, and its severity appears to correlate with body mass index (BMI).Aim:The aim of this study is to investigate the status of GERD after laparoscopic sleeve gastrectomy (LSG).Materials and Methods:A prospectively maintained database of all the patients who underwent LSG from February 2008 to May 2011 was reviewed.Results:A total of 131 patients were included. The mean age and the BMI of the patients were 49.4 years and 48.9 kg/m2, respectively. Prior to LSG, subjective reflux symptoms were reported in 67 (51%) patients. Anatomical presence of hiatal hernia was endoscopically confirmed in 35 (52%) patients who reported reflux symptoms prior to LSG. All these patients underwent simultaneous hiatal hernia repair during their LSG. The overall mean operative time was 106 min (range: 48-212 min). There were no intra- and 30-day postoperative complications. Out of the 67 preoperative reflux patients, 32 (47.7%) reported resolution of their symptoms after the operation, 20 (29.9%) reported clinical improvement, and 12 (22.2%) reported unchanged or persistent symptoms. Three patients developed new-onset reflux symptoms, which were easily controlled with proton pump inhibitors. No patient required conversion to gastric bypass or duodenal switch because of the severe reflux symptoms. At 18 months, the follow-up data were available in 60% of the total patients.Conclusion:LSG results in resolution or improvement of the reflux symptoms in a large number of patients. Proper patient selection, complete preoperative evaluation to identify the presence of hiatal hernia, and good surgical techniques are the keys to achieve optimal outcomes.
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BACKGROUNDLaparoscopic sleeve gastrectomy (LSG) has been established as an effective means of weight loss. Multiple studies report LSG as a cost-effective procedure with few perioperative complications.OBJECTIVESReport long-term weight changes after LSG in a single center in Kuwait.DESIGNRetrospective analysis of data collected 5–8 years after surgery.SETTINGA single medical center.PATIENTS AND METHODSAll patients that had undergone LSG between December 2008 and December 2011.MAIN OUTCOME MEASURESWeight changes, short-term complications following surgery (within one month).SAMPLE SIZE187.RESULTSThe mean age at the time of the surgery was 36.5 (10.3) years. Females composed 71.6% of this study population. Two patients (1.1%) presented with a leak within 30 days of the surgery. Twenty-one (11.2%) patients underwent revisional bariatric surgery after LSG. Mean (SD) BMI decreased from 47.1 (8.3) kg/m2 before surgery to 34.3 (7) kg/m2 5–8 years after surgery. Mean (SD) body weight decreased from 126.3 (25.3) kg to 91.6 (19.9) kg 5–8 years following LSG. The mean excess body weight loss was 58.8% (29.2%).CONCLUSIONLSG is a bariatric procedure with low complications and mortality in relation to other forms of bariatric surgery. It is associated with a significant improvement in weight loss in the long term.LIMITATIONSRecall bias due to the nature of collecting the data, small sample size.
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Background The actual effect of laparoscopic sleeve gastrectomy (LSG) on patients having gastroesophageal reflux disease (GERD) symptoms is still controversial. Repair of accidently discovered hiatus hernia during LSG is commonly advocated by many authors; however, data are not enough on the outcomes of GERD symptoms in these patients. The aim of this study is to evaluate the effect of restoration of gastroesophageal junction complex as protective mechanism through concomitant hiatal hernia repair, proper dissection of 2–3 cm of intraabdominal esophagus, and stitching of gastroesophageal junction to left crus of diaphragm on GERD symptoms in morbidly obese patients undergoing LSG. Patients and methods This is an observational study including 40 patients who previously have had LSG with crural repair and stitching of gastroesophageal junction to left crus of diaphragm in the same operation. Patients were treated at Ain Shams University hospitals from January 2017 to January 2019. Results The mean age of the study population was 37±11 years (range, 20–55 years). The mean BMI of the morbidly obese patients was 43.95±2.58 (40–49). Symptoms of GERD were presented only in 28 (70%) patients collected by GERD-Health Related Quality of Life questionnaire, and hiatal hernia was diagnosed in them by preoperative upper endoscopy. The mean follow-up was 6 months during which remission of GERD symptoms occurred in 36 (90%) patients along with regression of esophagitis as diagnosed by upper endoscopy 6 months postoperatively. Conclusion Sleeve gastrectomy with concomitant crural repair and stitching of gastroesophageal junction to left crus of diaphragm is considered a feasible and safe technique providing good results in management of GERD symptoms for obese patients with reflux symptoms and hiatus hernia.
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