Gastroesophageal reflux after sleeve gastrectomy. Fact or fiction?

Tomasicchio, G.; D’Abramo, F.; Dibra, Rigers; Trigiante, Giuseppe; Picciariello, Arcangelo; Dezi, Agnese; Rotelli, Maria Teresa; Ranaldo, Nunzio; Leo, Alfredo Di; Martines, Gennaro

doi:10.1016/j.surg.2022.04.040

Cited by 5 publications

(1 citation statement)

References 29 publications

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“…Nevertheless, after improving the surgical performance of LSG and carefully avoiding the technical issues (obstructions, twists or narrowing of the gastric tube), positive effects on GERD were noticed after this procedure [ 5 , 6 ], hence, explained by the reduced intra-abdominal pressure after weight loss, a reduced acid production, and the accelerated gastric emptying [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Hutopilă

Ciocoiu²,

Paunescu³

et al. 2023

Surg Endosc

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Background Laparoscopic Sleeve Gastrectomy (LSG) is the most attractive bariatric procedure, but the postoperative intrathoracic gastric migration (ITM) and “de novo” GERD are major concerns. The main objective of our study was to evaluate the efficiency of the concomitant HHR with or without partial reconstruction of phreno-esophageal ligament (R-PEL) to prevent ITM after LSG. The secondary objectives focused on procedure’s metabolic and GERD-related outcomes. Patients and method Consecutive patients who underwent primary LSG and concomitant HHR were included in a single-center prospective study. According to the HHR surgical technique, two groups were analyzed and compared: Group A included patients receiving crura approximation only and Group B patients with R-PEL. The patients’ evolution of co-morbidities, GERD symptoms, radiologic, and endoscopic details were prospectively analyzed. Results Two hundred seventy-three patients undergoing concurrent HHR and LSG were included in the study (Group A and B, 146 and 127 patients) The mean age and BMI were 42.6 ± 11.3 and 43.4 ± 6.8 kg/m 2 . The 12-month postoperative ITM was radiologically found in more than half of the patients in Group A, while in group B, the GEJ’s position appeared normal in 91.3% of the patients, meaning that R-PEL reduced 7 times the rate of ITM. The percentage of no-improvement and “de novo” severe esophagitis (Los Angeles C) was 4 times higher in group A 3.4% vs. 0.8% with statistical significance, and correlated to ITM. The GERD symptoms were less frequent in Group B vs Group A, 21.3% vs 37%, with statistical significance. No Barrett’s esophagus and no complication were recorded in any of the patients. Conclusion Concurrent LSG and HHR by crura approximation only has a very high rate of ITM in the first postoperative year (over 50%). R-PEL is an innovative technique which proved to be very efficient in preventing the ITM after HHR.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of the phreno-esophageal ligament (R-PEL) prevents the intrathoracic migration (ITM) after concomitant sleeve gastrectomy and hiatal hernia repair

Hutopilă

Ciocoiu²,

Paunescu³

et al. 2023

Surg Endosc

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The Management of Intractable Gastroesophageal Reflux Following Sleeve Gastrectomy: A Narrative Review

Chan,

Chen,

Indja

et al. 2024

Curr Surg Rep

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Purpose of Review Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric surgery in the world and is widely considered safe and effective for weight loss in the obese population. However, intractable gastroesophageal reflux disease (GERD) following LSG poses a clinical challenge, with significant impact on quality of life and the potential for development of Barrett’s esophagus This review aims to provide clinicians with a systematic approach to investigating and managing patients with intractable GERD following LSG. Recent Findings Management of GERD following LSG requires thorough clinical, anatomical and functional assessment in order to accurately diagnose GERD. Management should then be tailored to the patient in an integrated approach, with medical, endoscopic and/or operative interventions. Medical therapy includes PPIs and lifestyle therapy and are well established for GERD in the post-LSG population but limited in efficacy for severe disease. Endoscopic treatments such as anti-reflux mucosectomy and endoscopic radiofrequency ablation are novel, and benefits are still unclear. Operative interventions include conversion to Roux-en-Y gastric bypass with or without hiatal hernia repair, one anastomosis gastric bypass, duodenal switch, hiatal hernia repair or insertion of a Linx ™ device. These options have predominantly been studied in weight-loss failure post-LSG, with emerging evidence now in the treatment of intractable GERD following LSG. Summary A three-pronged assessment including clinical factors, anatomical evaluation and functional studies are required to accurately diagnose intractable GERD following LSG. Following this, individualised management with medical therapy, endoscopic and/or operative interventions should be considered with the patient within a multidisciplinary healthcare setting.

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