Gastroesophageal reflux related changes after sleeve gastrectomy and sleeve gastrectomy with fundoplication: A retrospective single center study

Abstract

BackgroundThe worsening of gastroesophageal reflux disease (GERD) and “de novo” GERD after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the patient’s quality of life; the incidence of GERD after LSG is up to 35%. Laparoscopic sleeve gastrectomy with fundoplication (LSGFD) is a new procedure which is considered to be better for patients with morbid obesity and GERD, but there is a lack of objective evidence to support this statement. This study aimed to assess the effectiveness, safety, and results of LSG and LSGFD on patients who were morbidly obese with or without GERD over an average of 34 months follow-up.MethodsFifty-six patients who were classified as obese underwent surgery from January 2018 to January 2020. Patients who were obese and did not have GERD underwent LSG and patients who were obese and did have GERD underwent LSFGD. The minimum follow-up time was 22 months and there were 11 cases lost during the follow-up period. We analyzed the short-term complications and medium-term results in terms of weight loss, incidence of de novo GERD/resolution of GERD, and remission of co-morbidities with follow-up.ResultsA total of 45 patients completed the follow-up and a questionnaire-based evaluation (GERD-Q), of whom 23 patients underwent LSG and 22 patients underwent LSGFD. We had 1 case of leak after LSGFD.No medium or long- term complications. The patient’s weight decreased from an average of 111.6 ± 11.8 Kg to 79.8 ± 12.2 Kg (P = 0.000) after LSG and from 104.3 ± 17.0 Kg to 73.7 ± 13.1 Kg (P = 0.000) after LSGFD. The GERD-Q scores increased from 6.70 ± 0.5 to 7.26 ± 1.7 (P = 0.016) after LSG and decreased from 8.86 ± 1.3 to 6.45 ± 0.8 (P = 0.0004) after LSGFD. The incidence of de novo GERD after LSG was 12 (52.2%) at the 12 month follow-up and 7 (30.4%) at the mean 34 (22–48) month follow-up. The remission of reflux symptoms, for patients who underwent LSGFD, was seen in 19 (86.4%) of 22 patients at 12 months and 20 (90.9%) of 22 patients at the mean 34 (22-48) month follow-up. The two groups did not have any significant difference in the effect of weight reduction and comorbidity resolution.ConclusionThe incidence of de novo GERD after LSG is high,LSG resulted in the same weight loss and comorbidity resolution as LSGFD, in patients who are morbidly obese and experience GERD, and LFDSG prevent the occurrence and development of GERD, combination of LSG with fundoplication (LSGFD) is a feasible and safe procedure with good postoperative results,which worthy of further clinical application.

Correlation analysis between the changes in plasma ghrelin level and weight loss after sleeve gastrectomy combined with fundoplication

“…Therefore, the weight loss mechanism following SGFD may be associated with a decrease in stomach capacity and the alteration of eating habits, as food passes through the gastroesophageal junction at a slower pace after gastric folding. Additionally, the research team’s previous investigations have shown remarkable weight loss effects of gastric fundus folding anti-reflux surgery [ 7 ]. We found an interesting phenomenon in the changes of blood sugar and triglyceride after SGFD.…”

“…The presence of Hiatal hernia (HH) prior to surgery further increases the risk of postoperative GERD. Recent studies by the author’s research team have demonstrated that laparoscopic fundoplication with sleeve gastrectomy (LFDSG) can effectively manage body weight and mitigate reflux symptoms [ 7 ]. The remission rate of reflux symptoms in patients who underwent SGFD can reach 86.4% one year after operation and 90.9% after an average follow-up of 34 (22–48) months.…”

“…On the basis of the above research [ 7 ], the aim of this study is to investigate the correlation between the alteration in Ghrelin levels and weight loss following SGFD, and to compare Ghrelin levels, weight loss and metabolic improvements between SG and LSGFD, with the objective of contributing to the existing body of knowledge on LSGFD technique in the management of patients with obesity and GERD.…”

Physiological Archetypes of de novo Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy

“…Recent data show that associating ARB-enhancing techniques during the LSG could prevent de novo or worsening GERD. 29,34,55 Therefore, it is reasonable to assume those procedures act by physiologically separating the proximal stomach and the esophagus, restoring, in part, the esophagogastric motor function.…”

Case Report: Acute Intrathoracic Sleeve Migration with Partial Volvulus after Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair

“…This report presents a case of acute incarcerated hiatal hernia with partial volvulus due to ITSM in a patient who underwent concomitant hiatal hernia repair with LSG. [1][2][3][4][5][6][7][8][9][10][11]…”