Long-Term Implications of GERD After Sleeve Gastrectomy

Bolckmans, Roel; Roriz-Silva, Renato; Mazzini, Guilherme S.; Altieri, Maria S.; Docimo, Salvatore; Campos, Guilherme M.

doi:10.1007/s40137-021-00284-8

Cited by 9 publications

(9 citation statements)

References 115 publications

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“…Although it is considered safe and effective, this approach is not flawless and without complications. In fact, LSG is sometimes linked to a worsening of GERD or de novo GERD [11,13], due to stricture, twist/torsion and retained fundus, with or without herniation [37]. Moreover, optimal sleeve construction is still a controversial issue [15]; hence, bioengineering methods are needed for further investigations.…”

Section: Discussionmentioning

confidence: 99%

Computational evaluation of laparoscopic sleeve gastrectomy

et al. 2021

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LSG is one of the most performed bariatric procedures worldwide. It is a safe and effective operation with a low complication rate. Unsatisfactory weight loss/regain may occur, suggesting that the operation design could be improved. A bioengineering approach might significantly help in avoiding the most common complications. Computational models of the sleeved stomach after LSG were developed according to bougie size (range 27–54 Fr). The endoluminal pressure and the basal volume were computed at different intragastric pressures. At an inner pressure of 22.5 mmHg, the basal volume of the 54 Fr configuration was approximately 6 times greater than that of the 27 Fr configuration (57.92 ml vs 9.70 ml). Moreover, the elongation distribution of the gastric wall was assessed to quantify the effect on mechanoreceptors impacting satiety by differencing regions and layers. An increasing trend in elongation strain with increasing bougie size was observed in all cases. The most stressed region and layer were the antrum (approximately 25% higher stress than that in the corpus at 37.5 mmHg) and mucosa layer (approximately 7% higher stress than that in the muscularis layer at 22.5 mmHg), respectively. In addition, the pressure–volume behaviors were reported. Computational models and bioengineering methods can help to quantitatively identify some critical aspects of the “design” of bariatric operations to plan interventions, and predict and increase the success rate. Moreover, computational tools can support the development of innovative bariatric procedures, potentially skipping invasive approaches.

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Section: Discussionmentioning

confidence: 99%

Computational evaluation of laparoscopic sleeve gastrectomy

et al. 2021

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“…Lastly, asymptomatic patients seeking bariatric surgery may also have abnormalities other than GERD on preoperative endoscopy that may influence surgical and clinical management. 36,40,41…”

Section: Outcomes Of Lrygb and Lsg Surgery In Patients With Gerdmentioning

confidence: 99%

“…There are other multiple other manuscripts documenting symptomatic improvement or GERD after a successful and properly done LRYGB 36 and LRYGB should be the procedure of choice for patients seeking treatment of obesity with associated GERD.…”

Section: Outcomes Of Lrygb and Lsg Surgery In Patients With Gerdmentioning

confidence: 99%

“…Luketina et al 28 retrospectively analyzed outcomes from 80 patients submitted to LARS. Forty patients (50%) were classified as lean weight (mean BMI 23.6, range [20][21][22][23][24][25] and forty patients (50%) were classified as obese (mean BMI 32.3, range [30][31][32][33][34][35][36][37][38][39][40][41][42]. Other Baseline clinical and demographic characteristics were similar in both groups, except for the BMI.…”

Section: Outcomes Of Lars In Patients With Class 1 2 and 3 Obesitymentioning

confidence: 99%

“…Lastly, asymptomatic patients seeking bariatric surgery may also have abnormalities other than GERD on preoperative endoscopy that may influence surgical and clinical management. 36,40,41 In view of the above, the use of preoperative endoscopy in patients seeking for bariatric surgery should be discussed with patients and considered as part of the preoperative work-up. As stated in a recent Position Statement by the American Society for Bariatric Surgery (ASMBS): "Given the current evidence of GERD outcomes following RYGB and LSG, patients with conclusive and objective evidence of preoperative GERD (EGD finding of esophagitis Los Angeles Classification grades C and D and/or a 24 or 48 hours pH test or pH-impedance testing with total acid exposure time greater than 6%) or severe GERD symptoms are better served by current techniques of RYGB rather than LSG.…”

Section: Preoperative Gerd Diagnosismentioning

confidence: 99%

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Surgical Management of Gastroesophageal Reflux in Patients With Obesity

Mazzini

Campos

2021

Foregut: The Journal of the American Foregut Society

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With the growing prevalence of obesity and its association with gastro-esophageal reflux disease (GERD), the thoracic, foregut, and bariatric surgeons will be ever more commonly facing the challenge to treat GERD in patients with obesity, albeit having the opportunity to treat GERD and obesity simultaneously. In this review, we outline the outcomes of laparoscopic antireflux surgery (LARS) in patients with Class 1, 2, and 3 obesity, as well as GERD outcomes of Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG). We also discuss the revisional surgical options for patients with obesity and failed LARS, or with GERD after LRYGB and LSG.

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SAGES guidelines for the management of comorbidities relevant to metabolic and bariatric surgery

Kumar,

Wunker,

Collings

et al. 2024

Surg Endosc

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Background Patients who are under consideration for or have undergone metabolic and bariatric surgery frequently have comorbid medical conditions that may make their perioperative care more complex. These recommendations address routine intraoperative cholangiography in patients with bypass-type anatomy, the management of reflux disease after sleeve gastrectomy, and the optimal bariatric procedure for patients with comorbid inflammatory bowel disease. Methods A systematic review was conducted including studies published from 1990 to 2022 to address these questions. These results were then presented to a panel of bariatric surgeons who formulated recommendations based on the best available evidence or utilized expert opinion when the evidence base was lacking. Results Conditional recommendations were made in favor of routine intraoperative cholangiography in patients with bypass-type anatomy undergoing laparoscopic cholecystectomy, trialing medical management prior to surgical management in patients with reflux after sleeve gastrectomy, and sleeve gastrectomy rather than Roux en Y gastric bypass in patients with inflammatory bowel disease. The strength of these recommendations was limited by the quality of evidence available. Recommendations for future research were made for all questions. Conclusions These recommendations should provide guidance regarding management of these comorbidities in patients who are under consideration for or have undergone metabolic and bariatric surgery. These recommendations also identify important areas where the future research should focus to strengthen the evidence base.

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Long-Term Implications of GERD After Sleeve Gastrectomy

Cited by 9 publications

References 115 publications

Computational evaluation of laparoscopic sleeve gastrectomy

Computational evaluation of laparoscopic sleeve gastrectomy

Surgical Management of Gastroesophageal Reflux in Patients With Obesity

SAGES guidelines for the management of comorbidities relevant to metabolic and bariatric surgery

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