Laparoscopic sleeve gastrectomy and gastroesophageal reflux

Abstract

Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery.

Bariatric surgery in Azerbaijan: a single center experience

“…Some publications of world literature indicated this range as 3-21%. [19,20] Our gastroesophageal reflux rate seems reasonable when compared with the reported results.…”

Does concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair increase morbidity?

“…A hiatal hernia is present in approximately half of obese patients [5,12]. Hiatal hernia not only exacerbates reflux symptoms but also may lead to the incomplete removal of the gastric fundus during SG [3].…”

“…Obesity is one of the most important health problems in developed and developing countries [1][2][3]. Morbid obesity is defined as a body mass index (BMI) of more than 40 kg/m².…”

Does Contouring of the Sleeve Help Prevent de novo GERD after Laparoscopic Sleeve Gastrectomy? A Nonrandomized Study

“…Therefore, although we are not against HHR during LSG, we suggest focus be directed to contouring of the sleeved stomach to prevent de novo GERD after LSG, because it is our point of view that the primary mechanism of de novo GERD after LSG is a lack of gastric compliance and increased intraluminal pressure caused by gastric fundus removal. Stenard and colleagues suggested that final shape of the sleeve affects the incidence of de novo GERD (e.g., narrowing, twisting, and dilatation of the sleeve stomach) [6]. In this regards, our focus in performing LSG was on three anatomical points: 1) fixation of the sleeved stomach in retroperitoneal or mesocolic fat; 2) a wider distance stapling to avoided narrowing the gastric angle; and 3) antral plication (rather than resection) for minimize delayed gastric emptying.…”

“…Many studies have been performed on conversion LSG to gastric bypass due to intolerable GERD after LSG [2][3][4][5], and many suggestions have been made regarding the cause of GERD [6]. High intraluminal pressure from narrow tube-like stomach with an intact pylorus sphincter play a major role in the development of GERD or a low esophageal sphincter complex (e.g.…”