Abstract
ABSTRACT Background:Sleeve gastrectomy may alter esophageal motility and lower esophageal sphincter pressure. Aim:To detect manometric changings in the esophagus and lower esophageal sphincter before and after sleeve gastrectomy in order to select patients who could develop postoperative esophageal motilitity disorders and lower esophageal sphincter pressure modifications. Methods:Seventy-three patients were selected. All were submitted to manometry before the operation and one year after. The variables analyzed were: resting pressure of the lower esophageal sphincter, contraction wave amplitude, duration of contraction waves, and esophageal peristalsis. Data were compared before and after surgery and to the healthy and non-obese control group. Exclusion criteria were: previous gastric surgery, reflux symptoms or endoscopic findings of reflux or hiatal hernia, diabetes and use of medications that could affect esophageal or lower esophageal sphincter motility. Results:49% of the patients presented preoperative manometric alterations: lower esophageal sphincter hypertonia in 47%, lower esophageal sphincter hypotonia in 22% and increase in contraction wave amplitude in 31%. One year after surgery, manometry was altered in 85% of patients: lower esophageal sphincter hypertonia in 11%, lower esophageal sphincter hypotonia in 52%, increase in contraction wave amplitude in 27% and 10% with alteration in esophageal peristalsis. Comparing the results between the preoperative and postoperative periods, was found statistical significance for the variables of the lower esophageal sphincter, amplitude of contraction waves and peristalsis. Conclusion:Manometry in the preoperative period of sleeve gastrectomy is not an exam to select candidates to this technique.
Highlights
Obesity is associated with an increased incidence of gastroesophageal reflux (GER)[9]
Vertical gastrectomy is a good option for weight loss, but transforming the stomach into a cylindrical structure and altering the anatomy of the esophagogastric junction, it may alter the function of the lower esophageal sphincter (LES) and, some patients submitted to this technique may develop GER5,6,12
The purpose of this study was to determine the manometric changes of the LES and esophageal body before and after performing vertical gastrectomy compared to healthy volunteers
Summary
Obesity is associated with an increased incidence of gastroesophageal reflux (GER)[9]. Weight loss determined by bariatric surgery can reduce these symptoms. Vertical gastrectomy is a good option for weight loss, but transforming the stomach into a cylindrical structure and altering the anatomy of the esophagogastric junction, it may alter the function of the lower esophageal sphincter (LES) and, some patients submitted to this technique may develop GER5,6,12. Several studies have studied the symptoms of GER in the postoperative period of vertical gastrectomy, but few have evaluated the esophagogastric junction[3,16]. The purpose of this study was to determine the manometric changes of the LES and esophageal body before and after performing vertical gastrectomy compared to healthy volunteers. The hypothesis was that surgical manipulation near the esophagogastric angle during the operation could affect LES function and esophageal motility
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