Improvement of Gastroesophageal Reflux Symptoms After Standardized Laparoscopic Sleeve Gastrectomy

Abstract

Gastroesophageal reflux disease (GERD) is present in half of morbidly obese patients. Published data reporting the results of laparoscopic sleeve gastrectomy (LSG) in patients with GERD are contradictory. We have shown in a previous study that symptoms of GERD can be reduced for up to 12months after LSG with careful attention to surgical technique. The present study prospectively evaluated the effect of a standardized LSG technique on the incidence of postoperative GERD symptoms in a larger sample, and followed patients for up to 22months. This was a concurrent cohort study. All patients who underwent LSG at our center completed a standard multidisciplinary preoperative evaluation and were followed prospectively. A total of 382 patients underwent surgery. There were no cases of death or fistula. GERD was diagnosed in 170 patients (44.5%) preoperatively, and hiatal hernia (HH) was detected in 142 patients (37.2%) intraoperatively. Between 6 and 22months postoperatively, 373 patients were completely evaluated. Ten (2.6%) had GERD symptoms 6-22months postoperatively, and 94% of patients with preoperative GERD symptoms were asymptomatic at follow-up 6-22months after LSG. Only 1 patient (0.5%) of a subgroup of 174 without HH or esophagitis at preoperative evaluation had GERD at follow-up. Our results confirm that, contrary to previous reports of LSG in the literature, careful attention to surgical technique can result in significantly reduced GERD symptoms up to 22months postoperatively suggesting that LSG does not predispose patients to GERD during that period.