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Does hiatal repair affect gastroesophageal reflux symptoms in patients undergoing laparoscopic sleeve gastrectomy?

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a treatment of choice for morbid obesity and associated comorbidities. There has been a concern about new onset or worsening of gastroesophageal reflux (GERD) following LSG.

Objective

The objective of the study was to evaluate the effect of surgically treating hiatal weakness on GERD symptoms in patients undergoing LSG.

Setting

Single tertiary referral institution, Sydney, Australia.

Methods

A prospective observational cohort study was conducted with consecutive patients undergoing LSG. Hiatal findings, patient demographics, medications and reflux score were recorded prospectively. Patients were followed up post-operatively for a minimum of 12 months and assessed using GERD-HRQL score to quantify reflux symptoms.

Results

Data from 100 patients with a minimum of 1-year follow-up were analysed. Mean follow-up was 18.9 months. Overall, GERD-HRQL improved from mean 4.5 ± 5.8 pre-operatively to 0.76 ± 1.5 after 18.9 months (p = 0.0001). For those with pre-operative reflux, GERD-HRQL improved from mean (SD) 8.43 ± 6.26 pre-operatively to 0.94 ± 1.55 (p = 0.0001). All the nine patients with troublesome daily reflux significantly improved. For those without pre-operative reflux, GERD-HRQL improved from 0.88 ± 1.37 to 0.47 ± 1.25 (p-ns) post-operatively. On multivariate analysis, higher pre-operative reflux and dysphagia/bloat scores, younger age and lower percentage excess weight loss after 18.9 months were associated with GERD-HRQL improvement.

Conclusion

In the medium term, GERD-HRQL improves following sleeve gastrectomy with meticulous hiatal assessment and repair of hiatal laxity and herniation.

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Acknowledgements

Statistics- Ms Emma Aitken, Surgical registrar, Queen Elizabeth, University Hospital, Glasgow, UK.

Author information

Authors and Affiliations

  1. Concord Repatriation General Hospital, Hospital Road, Concord, NSW, 213, Australia

    Philip Le Page, David Martin, Craig Taylor, Jennifer Wang, Gregory Falk & Simon C. Gibson

  2. Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, UK

    Himanshu Wadhawan & Simon C. Gibson

  3. Department of Surgery, Queen Elizabeth University Hospital, Govan Road, Glasgow, G51 4TF, UK

    Himanshu Wadhawan

Authors
  1. Philip Le Page
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  2. David Martin
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Corresponding author

Correspondence to Himanshu Wadhawan.

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Disclosures

Philip Le Page, David Martin, Craig Taylor, Jennifer Wang, Himanshu Wadhawan, Gregory Falk and Simon C Gibson have no conflicts of interest or financial ties to disclose.

Appendix

Appendix

GERD-HRQL Scale

0 = No symptoms

1 = Symptoms noticeable, but not bothersome

2 = Symptoms noticeable and bothersome, but not every day

3 = Symptoms bothersome everyday

4 = Symptoms affect daily activities

5 = Symptoms are incapacitating- unable to do daily activities

Please circle the correct response to the following questions

  1. 1.

    How bad is your heartburn? 0 1 2 3 4 5

  2. 2.

    Heartburn when lying down? 0 1 2 3 4 5

  3. 3.

    Heartburn when standing up? 0 1 2 3 4 5

  4. 4.

    Heartburn after meals? 0 1 2 3 4 5

  5. 5.

    Does heartburn change your diet? 0 1 2 3 4 5

  6. 6.

    Does heartburn wake you from sleep? 0 1 2 3 4 5

  7. 7.

    Do you have difficulty swallowing? 0 1 2 3 4 5

  8. 8.

    Do you have pain with swallowing? 0 1 2 3 4 5

  9. 9.

    Do you have gassy or bloating feelings? 0 1 2 3 4 5

  10. 10.

    If you take medication, does it affect your 0 1 2 3 4 5 daily life?

How satisfied are you with your present condition? Satisfied, Neutral, Dissatisfied.

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Page, P.L., Martin, D., Taylor, C. et al. Does hiatal repair affect gastroesophageal reflux symptoms in patients undergoing laparoscopic sleeve gastrectomy?. Surg Endosc 32, 2373–2380 (2018). https://doi.org/10.1007/s00464-017-5935-9

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  • DOI: https://doi.org/10.1007/s00464-017-5935-9

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