Laparoscopic Roux en Y Gastric Bypass versus Sleeve Gastrectomy in the Management of Gastroesophageal Reflux Disease: A cohort study

Abstract

Background: Gastroesophageal reflux disease (GERD) is considered to be one of the most prevalent diseases of the gastrointestinal system all over the world. One of the major risk factors of GERD is morbid obesity. During the last decade, the prevalence of obesity has increased significantly around the world. Many studies have suggested the association between obesity and GERD symptoms. The effect of weight loss on decreasing the incidence and severity of GERD symptoms was found to be significant, and weight loss is considered to be one of the most important lines in managing GERD symptoms. Aim:We aim to compare between the use of laparoscopic Sleeve Gastrectomy and Roux-en-Y gastric bypass in the Management of morbid obese patients with Gastroesophageal Reflux Disease GERD) and decide which approach is associated with the best short and long term effects on the prevalence and symptoms of Gastroesophageal reflux disease (GERD). Patients and methods:A retrospective study is conducted in Ain Shams University Surgery Hospital during the period between March 2014 and July 2018. We included patients with Gastroesophageal reflux disease (GERD) to undergo bariatric surgery (RYGB vs Sleeve gastrectomy) in our hospital including a body mass index of more than 35 kg/m 2 , aged between 18 and 65, with one or more co-morbidity and with failure of conservative treatment of obesity over a period of more than 2 years. We excluded patients with general contraindications to abdominal surgery, patients with grade 3 or 4 Gastroesophageal reflux disease (GERD), patients with Large size Hiatal hernias (more than 2 cm), patients with history of previous major abdominal operations and patient with inflammatory bowel disease.Results: A total number of 110 patients have been enrolled in our study. Both groups were similar in terms of age, sex, weight, average BMI and other co-morbidities such as diabetes, hypertension and dyslipidemia. The changes in GERD score were significantly higher in the LRYGB patients (56.5%) compared to (41%) in the LSG group. Patients, mostly in LSG group, experienced worsening of the GERD symptoms. Conclusion:Both the most common bariatric surgery procedures were associated with improved GERD symptoms. We consider the Roux-en-Y gastric bypass to be the superior operation technique in improving GERD symptoms. Sleeve gastrectomy was associated with more de-novo GERD symptoms development. Some recent guidelines consider having a preoperative GERD symptom to be a contraindication to performing sleeve gastrectomy.