Moderating the Enthusiasm of Sleeve Gastrectomy: Up to Fifty Percent of Reflux Symptoms After Ten Years in a Consecutive Series of One Hundred Laparoscopic Sleeve Gastrectomies

Feb 13, 2017Obesity surgery

Up to Half of Patients Have Reflux Symptoms Ten Years After Sleeve Gastrectomy Surgery

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Abstract

A mean follow-up of 8.48 years showed a 60% excess weight loss after laparoscopic sleeve gastrectomy (LSG).

A significant increase in gastroesophageal reflux disease (GERD) symptoms occurred, with 50% of patients reporting reflux at follow-up compared to 17% preoperatively.
The risk of developing new reflux after LSG was 47.8%, affecting 32 out of 67 patients evaluated.
Severe GERD symptoms led to secondary surgery in some cases, with 57.1% of those patients experiencing complete resolution of reflux after conversion to Roux-en-Y gastric bypass (RYGB).
Increased dependency on proton pump inhibitors (PPIs) was observed post-surgery.
While effective for weight loss, LSG is associated with a notable rise in reflux disease and PPI use.

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BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become a popular one-stage bariatric procedure with a proven efficacy on weight loss. However, the relationship between LSG and gastroesophageal reflux disease (GERD) remains a subject of debate. The objective is to determine the long-term effect of LSG on weight loss and reflux disease.

METHODS: A retrospective analysis of 100 consecutive patients who underwent an LSG between January 2005 and March 2009 was performed. The effect of LSG on weight evolution and the relationship between preoperative and postoperative GERD symptoms and PPI dependency was analyzed.

RESULTS: A mean follow-up of 8.48 years (range 6.1-10.3) was achieved. We observed a long-term % excess weight loss (%EWL) of 60%. A significant increase in reflux symptoms and use of PPIs was seen. Seventeen percent suffered from reflux disease preoperatively versus 50% at the end of the postoperative follow-up (RR = 2.5882, 95% CI [1.6161-4.1452], p value = 0.0001). The chance of developing de novo reflux after LSG was 47.8% (32/67). Reflux disease was present in 7 of the 26 patients who underwent a secondary Roux-en-Y gastric bypass (RYGB). In four of these seven patients, reflux disease disappeared completely after the secondary RYGB (57.1%).

CONCLUSIONS: A satisfactory long-term effect on weight loss was achieved. However, a significant increase in GERD and PPI dependency after LSG was noted. New onset GERD was seen in more than 40% of the study population. Conversion to RYGB is a good option in patients with refractory reflux disease after LSG.

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Moderating the Enthusiasm of Sleeve Gastrectomy: Up to Fifty Percent of Reflux Symptoms After Ten Years in a Consecutive Series of One Hundred Laparoscopic Sleeve Gastrectomies

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