VERTICAL GASTRECTOMY VS. EXTENDED VERTICAL GASTRECTOMY: WHAT IS THE IMPACT ON GASTROESOPHAGEAL REFLUX DISEASE IN OBESE RATS?

José Aparecido Valadão,Paulo Afonso Nunes Nassif,Ozimo Pereira Gama-Filho,Luis Eduardo Veras Pinto,Marco Aurelio Santo,Eduardo José Silva Gomes De Oliveira,Danilo Dallago De Marchi,Orlando Jorge Martins Torres,Plinio Da Cunha Leal

doi:10.1590/0102-672020190001e1513

Abstract

ABSTRACT Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.

Highlights

Vertical gastrectomy (VG) has not yet had its surgical technique fully standardized
The extended vertical gastrectomy (EVG) is a technical variation of the VG proposed by Nassif et al[18]
Studies using 24hour impedance-pH-monitoring to assess the presence of gastroesophageal reflux in patients undergoing VG concluded that 50% of those ones studied started to have Gastroesophageal reflux disease (GERD) and that it worsened in 80% of those who already had the disease[8]

Summary

Introduction

Vertical gastrectomy (VG) has not yet had its surgical technique fully standardized. The procedure consists of removing an extensive part of the large curvature of the stomach, part of the body and the entire gastric fundus, making a reservoir of smaller volume and tubular shape[29]. The extended vertical gastrectomy (EVG) is a technical variation of the VG proposed by Nassif et al[18]. In this technique, the first staples are parallel to the largest axis of the pylorus, narrowing the antropyloric region. 35,36 In this context, experimental studies aiming at elucidating the relation between VG and GERD are of great importance, since the aspects that address this surgical treatment for obesity and GERD are divergent in the literature and should be further investigated. The aim of this research was to compare VG and EVG techniques in a single experimental study regarding to GERD, as they are surgical treatments for obesity

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Results

Conclusion