Functional Importance of Laparoscopic Sleeve Gastrectomy for the Lower Esophageal Sphincter in Patients with Morbid Obesity

Abstract

LSG significantly increased lower esophageal pressure independent of weight loss after LSG and may protect obese patients from gastroesophageal reflux.

Outcomes of laparoscopic sleeve gastrectomy by means of esophageal manometry and pH-metry, before and after surgery.

“…Several studies have reported a fall in LESP after LSG [14,19]. However, other studies have stated that LESP remains stable without changing, and some have even reported an increase [20,21]. Petersen reported an increase in sphincter tonus, which was reflected in the manometric measurement of the surgical technique applied independently of weight loss [20].…”

“…However, other studies have stated that LESP remains stable without changing, and some have even reported an increase [20,21]. Petersen reported an increase in sphincter tonus, which was reflected in the manometric measurement of the surgical technique applied independently of weight loss [20]. A loss of sphincter length and the destruction of the angle of His have been considered the most responsible for the decrease in LESP [22].…”

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

“…The authors proposed the partial section of the sling fibers of the cardias as cause of these findings. On the contrary, Petersen et al[20] reported an increase in LES pressure regardless of the weight loss, suggesting that this manometric change is related to the position of the stapler in relation to the angle of His. Specifically, the closer the staple line to the gastroesophageal junction, the higher the LES pressure.…”

“…Most studies defined GERD based on proton pump inhibitors (PPIs) use, symptoms evaluation, and presence of esophagitis. Only few studies objectively analyzed patients by esophageal manometry and 24-pH monitoring[15,20,29,33,34,38,40,43,44]. …”

“…Regarding manometric changes, very controversial data have been published[15,20,29,33,34,38,40]. Some small studies have found a significant decrease in lower esophageal sphincter (LES) pressure, while others showed a significant increase in LES pressure postoperatively.…”