Symptoms of Gastroesophageal Reflux Following Laparoscopic Sleeve Gastrectomy Are Related to the Final Shape of the Sleeve as Depicted by Radiology

Abstract

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity as a primary procedure in selected morbidly obese patients. Like most other bariatric procedures LSG results in alterations of the upper GI anatomy that might affect gastroesophageal reflux postoperatively. The study was conducted to assess the presence of reflux symptoms in patients before and after laparoscopic sleeve gastrectomy and any possible relation of these symptoms to the postoperative gastric anatomy as depicted by gastrografin swallow studies. The study included 85 consecutive morbidly obese patients who underwent LSG as a primary bariatric procedure. Patients were evaluated for symptoms of gastroesophageal reflux (heartburn, regurgitation, and vomiting) preoperatively and at 1 and 6months and 1year postoperatively. To assess the postoperative gastric anatomy, the gastrografin studies that were routinely performed in all patients on the third postoperative day were retrospectively evaluated. Changes of each one of the reflux symptoms were assessed in relation to the radiological pattern of the gastric sleeve. Three radiological patterns of the gastric sleeve were identified: (a) the tubular (65.9%), (b) the superior pouch (25.9%), and (c) the inferior pouch pattern (8.2%). Patients showed an overall tendency towards relief of heartburn and increase of regurgitation and vomiting postoperatively. However, only changes in regurgitation and vomiting were found to be statistically significant (p < 0.01); interestingly, those were observed in patients with the tubular gastric pattern. The final shape of the gastric sleeve as depicted by radiological studies seems to have an impact on reflux symptoms after laparoscopic sleeve gastrectomy.