Abstract
Background
Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem.
Methods
We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy.
Results
We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication.
Conclusion
A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.
Similar content being viewed by others
References
Wheeler E, Prettyman A, Lenhard MJ, Tran K (2008) Adherence to outpatient program postoperative appointments after bariatric surgery. Surg Obes Relat Dis 4:515–520. doi:10.1016/j.soard.2008.01.013
Sturm R (2007) Increases in morbid obesity in the USA: 2000–2005. Public Health 121:492–496. doi:10.1016/j.puhe.2007.01.006
Fryar CD, Carroll MD, Ogden CL (2014) Prevalence of overweight, obesity, and extreme obesity among adults: United States, 1960–1962 through 2011–2012. Centers for Disease Control National Center for Health Statistics 1–6
Harper J, Madan AK, Ternovits CA, Tichansky DS (2007) What happens to patients who do not follow-up after bariatric surgery? Am Surg 73:181–184
Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23:427–436
Daes J, Jimenez ME, Said N, Daza JC, Dennis R (2012) Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg 22:1874–1879. doi:10.1007/s11695-012-0746-5
Clapp B (2013) Prosthetic bioabsorbable mesh for hiatal hernia repair during sleeve gastrectomy. JSLS J Soc Laparoendosc Surg 17:641
Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ (1999) Risk factors associated with symptoms of gastroesophageal reflux. Am J Med 106:642–649. doi:10.1016/S0002-9343(99)00121-7
Braghetto I, Lanzarini E, Korn O, Valladares H, Molina JC, Henriquez A (2010) Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg 20:357–362. doi:10.1007/s11695-009-0040-3
Baltasar A, Serra C, Perez N, Bou R, Bengochea M, Ferri L (2005) Laparoscopic sleeve gastrectomy: a multi-purpose bariatric operation. Obes Surg 15:1124–1128. doi:10.1381/0960892055002248
Himpens J, Dapri G, Cadière GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16:1450–1456
Jossart GH, Anthone G (2010) The history of sleeve gastrectomy. Bariatric Times 7(2):9–10
Homan J, Betzel B, Aarts EO, van Laarhoven KJ, Janssen IM, Berends FJ (2014) Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. doi:10.1016/j.soard.2014.09.029
D’Hondt M, Vanneste S, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F (2011) Laparoscopic sleeve gastrectomy as a single-stage procedure for the treatment of morbid obesity and the resulting quality of life, resolution of comorbidities, food tolerance, and 6-year weight loss. Surg Endosc 25:2498–2504
Shi X, Karmali S, Sharma AM, Birch DW (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20:1171–1177. doi:10.1007/s11695-010-0145-8
Weiner RA, Weiner S, Pomhoff I, Jacobi C, Makarewicz W, Weigand G (2007) Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg 17:1297–1305
Liang WT, Wu JM, Wang ZG (2015) Modification of Belsey (Mark IV) fundoplication in the management of hiatal hernia and gastroesophageal reflux disease after sleeve gastrectomy: a case report. Surg Obes Relat Dis 11:e19–e20. doi:10.1016/j.soard.2014.11.020
Fujiwara Y, Nakagawa K, Kusunoki M, Tanaka T, Yamamura T, Utsunomiya J (1998) Gastroesophageal reflux after distal gastrectomy: possible significance of the angle of His. Am J Gastroenterol 93:11–15. doi:10.1111/j.1572-0241.1998.011_c.x
Tai C, Huang C, Lee Y, Chang C, Lee C, Lin J (2013) Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc 27:1260–1266
Carter PR, LeBlanc KA, Hausmann MG, Kleinpeter KP, Jones SM (2011) Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 7:569–572
Howard DD, Caban AM, Cendan JC, Ben-David K (2011) Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis 7:709–713
Cottam D, Qureshi F, Mattar S, Sharma S, Holover S, Bonanomi G, Ramanathan R, Schauer P (2006) Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc 20:859–863
Han SM, Kim WW, Oh JH (2005) Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg 15:1469–1475
Melissas J, Daskalakis M, Koukouraki S, Askoxylakis I, Metaxari M, Dimitriadis E, Stathaki M, Papadakis JA (2008) Sleeve gastrectomy—a “food limiting” operation. Obes Surg 18:1251–1256
Melissas J, Koukouraki S, Askoxylakis J, Stathaki M, Daskalakis M, Perisinakis K, Karkavitsas N (2007) Sleeve gastrectomy—a restrictive procedure? Obes Surg 17:57–62
Omana JJ, Nguyen SQ, Herron D, Kini S (2010) Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surg Endosc 24:2513–2517
Arias E, Martínez PR, Li VKM, Szomstein S, Rosenthal RJ (2009) Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg 19:544–548
Lakdawala MA, Bhasker A, Mulchandani D, Goel S, Jain S (2010) Comparison between the results of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in the Indian population: a retrospective 1 year study. Obes Surg 20:1–6
Nocca D, Krawczykowsky D, Bomans B, Noël P, Picot MC, Blanc PM, de Seguin de Hons C, Millat B, Gagner M, Monnier L, Fabre JM (2008) A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg 18:560–565
Hamoui N, Anthone GJ, Kaufman HS, Crookes PF (2006) Sleeve gastrectomy in the high-risk patient. Obes Surg 16:1445–1449
Menenakos E, Stamou KM, Albanopoulos K, Papailiou J, Theodorou D, Leandros E (2010) Laparoscopic sleeve gastrectomy performed with intent to treat morbid obesity: a prospective single-center study of 261 patients with a median follow-up of 1 year. Obes Surg 20:276–282
Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252:319–324. doi:10.1097/SLA.0b013e3181e90b31
Keidar A, Appelbaum L, Schweiger C, Elazary R, Baltasar A (2010) Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg 20:140–147
Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, Gfrerer L, Ludvik B, Zacherl J, Prager G (2010) Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 20:535–540
Chopra A, Chao E, Etkin Y, Merklinger L, Lieb J, Delany H (2012) Laparoscopic sleeve gastrectomy for obesity: can it be considered a definitive procedure? Surg Endosc 26:831–837
Sieber P, Gass M, Kern B, Peters T, Slawik M, Peterli R (2014) Five-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 10:243–249
Rawlins L, Rawlins MP, Brown CC, Schumacher DL (2013) Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis 9:21–25
Ellatif MA, Abdallah E, Askar W, Thabet W, Aboushady M, Abbas A, El Hadidi A, Elezaby A, Salama A, Dawoud I (2014) Long term predictors of success after laparoscopic sleeve gastrectomy. Int J Surg 12:504–508
Catheline J, Fysekidis M, Bachner I, Bihan H, Kassem A, Dbouk R, Bdeoui N, Boschetto A, Cohen R (2013) Five-year results of sleeve gastrectomy. J visc surg 150:307–312
Burgerhart JS, Schotborgh CA, Schoon EJ, Smulders JF, van de Meeberg, Paul C, Siersema PD, Smout AJ (2014) Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg 24:1436–1441
Rice RD, Simon TE, Seery JM, Frizzi JD, Husain FA, Choi YU (2010) Laparoscopic sleeve gastrectomy: outcomes at a military training center. Am Surg 76:835–840
Sharma A, Aggarwal S, Ahuja V, Bal C (2014) Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis 10:600–605
Kular K, Manchanda N, Rutledge R (2014) Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: a report from the Indian sub-continent. Obes Surg 24:1724–1728
Carabotti M, Silecchia G, Greco F, Leonetti F, Piretta L, Rengo M, Rizzello M, Osborn J, Corazziari E, Severi C (2013) Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg 23:1551–1557
Albanopoulos K, Tsamis D, Natoudi M, Alevizos L, Zografos G, Leandros E (2016) The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: the results of 3 years of follow-up. Surg Endosc 30:699–705
Gorodner V, Buxhoeveden R, Clemente G, Solé L, Caro L, Grigaites A (2015) Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surg Endosc 29:1760–1768
Oor JE, Roks DJ, Ünlü Ç, Hazebroek EJ (2016) Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg 211:250–267
DuPree CE, Blair K, Steele SR, Martin MJ (2014) Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg 149:328–334
Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR, Perdikis G (1994) Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 220:472–481 (discussion 481-3). doi:10.1097/00000658-199410000-00006
Kahrilas PJ (2008) Gastroesophageal reflux disease. N Engl J Med 359:1700–1707. doi:10.1056/NEJMcp0804684
Kraemer SJ, Aye R, Kozarek RA, Hill LD (1994) Laparoscopic Hill repair. Gastrointest Endosc 40:155–159. doi:10.1016/S0016-5107(94)70158-X
Torquati A, Houston HL, Kaiser J, Holzman MD, Richards WO (2004) Long-term follow-up study of the Stretta procedure for the treatment of gastroesophageal reflux disease. Surg Endosc 18:1475–1479. doi:10.1007/s00464-003-9181-y
Wolfsen HC, Richards WO (2002) The Stretta procedure for the treatment of GERD: a registry of 558 patients. J Laparoendosc Adv Surg Tech A 12:395–402. doi:10.1089/109264202762252640
Triadafilopoulos G, DiBaise JK, Nostrant TT, Stollman NH, Anderson PK, Wolfe MM, Rothstein RI, Wo JM, Corley DA, Patti MG, Antignano LV, Goff JS, Edmundowicz SA, Castell DO, Rabine JC, Kim MS, Utley DS (2002) The Stretta procedure for the treatment of GERD: 6 and 12 month follow-up of the U.S. open label trial. Gastrointest Endosc 55:149–156. doi:10.1067/mge.2002.121227
Noar M, Squires P, Noar E, Lee M (2014) Long-term maintenance effect of radiofrequency energy delivery for refractory GERD: a decade later. Surg Endosc 28:2323–2333
Lipham JC, DeMeester TR, Ganz RA, Bonavina L, Saino G, Dunn DH, Fockens P, Bemelman W (2012) The LINX(R) reflux management system: confirmed safety and efficacy now at 4 years. Surg Endosc 26:2944–2949. doi:10.1007/s00464-012-2289-1
Sheu EG, Nau P, Nath B, Kuo B, Rattner DW (2015) A comparative trial of laparoscopic magnetic sphincter augmentation and Nissen fundoplication. Surg Endosc 29:505–509. doi:10.1007/s00464-014-3704-6
Bonavina L, Saino G, Lipham JC, Demeester TR (2013) LINX((R)) Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux. Ther Adv Gastroenterol 6:261–268. doi:10.1177/1756283X13486311
Bonavina L, DeMeester T, Fockens P, Dunn D, Saino G, Bona D, Lipham J, Bemelman W, Ganz RA (2010) Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure: 1 and 2-year results of a feasibility trial. Ann Surg 252:857–862. doi:10.1097/SLA.0b013e3181fd879b
Desart K, Rossidis G, Michel M, Lux T, Ben-David K (2015) Gastroesophageal reflux management with the LINX® system for gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. J Gastrointest Surg 19:1782–1786
Frezza E, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, Schauer P (2002) Symptomatic improvement in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg Endosc 16:1027–1031
Soricelli E, Iossa A, Casella G, Abbatini F, Calì B, Basso N (2013) Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis 9:356–361
Daes J, Jimenez ME, Said N, Dennis R (2014) Improvement of gastroesophageal reflux symptoms after standardized laparoscopic sleeve gastrectomy. Obes Surg 24:536–540
Sucandy I, Chrestiana D, Bonanni F, Antanavicius G (2015) Gastroesophageal reflux symptoms after laparoscopic sleeve gastrectomy for morbid obesity. The importance of preoperative evaluation and selection. North Am J Med Sci 7:189
Santonicola A, Angrisani L, Cutolo P, Formisano G, Iovino P (2014) The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients. Surg Obes Relat Dis 10:250–255
Fedenko V, Evdoshenko V (2007) Antireflux sleeve gastroplasty: description of a novel technique. Obes Surg 17:820–824
Johnston D, Dachtler J, Sue-Ling HM, King RF, Martin IG (2003) The Magenstrasse and Mill operation for morbid obesity. Obes Surg 13:10–16
Le Page PA, Martin D (2015) Laparoscopic partial sleeve gastrectomy with fundoplication for gastroesophageal reflux and delayed gastric emptying. World J Surg 39:1460–1464
Lee WJ, Han ML, Ser KH, Tsou JJ, Chen JC, Lin CH (2014) Laparoscopic Nissen fundoplication with gastric plication as a potential treatment of morbidly obese patients with GERD, first experience and results. Obes Surg 24:1447–1452. doi:10.1007/s11695-014-1223-0
Santoro S, Lacombe A, Aquino CGGD, Malzoni CE (2014) Sleeve gastrectomy with anti-reflux procedures. Einstein (São Paulo) 12:287–294
Funding
Funding for this study was provided by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center and the Foundation for Surgical Fellows.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Christopher Crawford, Kyle Gibbens, Daniel Lomelin, Crystal Krause, Anton Simorov, and Dmitry Oleynikov have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Crawford, C., Gibbens, K., Lomelin, D. et al. Sleeve gastrectomy and anti-reflux procedures. Surg Endosc 31, 1012–1021 (2017). https://doi.org/10.1007/s00464-016-5092-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-016-5092-6