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Sleeve gastrectomy morphology and long-term weight-loss and gastroesophageal reflux disease outcomes

  • 2022 SAGES Oral
  • Published:
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Abstract

Background

The relationship between sleeve gastrectomy (SG) morphology and long-term weight-loss and gastroesophageal reflux disease (GERD) outcomes is unknown.

Methods

All patients (n = 268) undergoing SG performed by 3 surgeons at a single academic institution from January 1, 2010 to December 31, 2012 were included. Long-term weight-loss and GERD outcomes were available for 90 patients which were incorporated in analyses. SG morphology was determined from postoperative day 1 upper gastrointestinal series (UGIS) available from 50 patients. Images were independently categorized using previously published methodology as Dumbbell (38%), Lower Pouch (22%), Tubular (26%), or Upper Pouch (14%) by Radiologist and Surgeon. Radiologist categorization was used when disagreement occurred (8%). Univariable analyses were conducted to explore potential associations between SG morphology, weight loss, and GERD outcomes.

Results

Follow-up was 8.2 ± 0.9 years. Population characteristics included age of 45.1 ± 10.8 years, female sex in 83.3%, and hiatal hernia repair (HHR) performed at index SG in 17.8%. Surgeons did not preferentially achieve a specific SG morphology. Changes from preoperative obesity and associated diseases comprised body mass index (BMI) (49.5 ± 7.6 vs. 39.2 ± 9.4 kg/m2; p < 0.0001), diabetes mellitus (30.0 vs. 12.2%; p = 0.0006), hypertension (70.0 vs. 54.4%; p = 0.0028), hyperlipidemia (42.2 vs. 24.2%;p = 0.0017), obstructive sleep apnea (41.1 vs. 15.6%; p < 0.0001), osteoarthritis (48.9 vs. 13.3%; p < 0.0001), back pain (46.5 vs. 28.9%; p = 0.0035), and medications (4.8 ± 3.3 vs. 3.7 ± 3.5; p < 0.0001). Dumbbell SG morphology was associated with lesser reduction in BMI at follow-up (-−6.8 ± 7.2 vs. −12.4 ± 8.3 kg/m2; p = 0.0196) while greater BMI change was appreciated with Lower Pouch SG shape (−16.9 ± 9.9 vs. −8.4 ± 6.8 kg/m2; p = 0.0017). GERD was more prevalent at follow-up than baseline (67.8 vs. 47.8%; p < 0.0001). GERD-specific outcomes included de novo (51.1%), persistent (27.9%), worsened (58.1%), and resolved (14.0%) disease. Ten patients underwent reoperation for refractory GERD with SG morphology corresponding to Dumbbell (n = 5) and Upper Pouch (n = 1) for those with available UGIS. Univariable analyses showed that patients with GERD experienced a larger reduction in BMI compared with patients without GERD (−11.8 ± 7.7 vs. −7.0 ± 5.1 kg/m2; p = 0.0007). Patient age, surgeon, morphology category, and whether a HHR was done at index SG were not associated with the presence of any, de novo, or worsened GERD. Female sex was associated with worsened GERD (96.0 vs. 4.0%; p = 0.0455). Type of calibration device, distance from staple line to pylorus, and whether staple line reinforcement was used were not associated with SG morphology classification.

Conclusion

This is the first study assessing the impact of SG morphology on long-term weight loss and GERD. Our data suggest an association between SG morphology and long-term weight loss but not with GERD outcomes. Current technical standards may be limited in reproducing the same SG morphology. This information may help guide the technical optimization and standardization of SG.

Graphical abstract

Surgeons did not favor a specific SG morphology (1). Our results signal to a relationship between radiographic assessment of SG morphology and long-term weight-loss outcomes with Dumbbell classification correlated with lesser reduction in BMI (2a) and Lower Pouch morphology associated with superior weight loss (2b). SG, sleeve gastrectomy; BMI, body mass index.

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  1. University Hospitals, 11100 Euclid Avenue, Lakeside 5047, Cleveland, OH, 44106, USA

    Rafael Alvarez, Joseph Youssef, Jonathan Zadeh, Anuja Sarode, Richard Barger, Mujjahid Abbas & Leena Khaitan

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Rafael Alvarez, Joseph Youssef, Jonathan Zadeh, Anuja Sarode, Richard Barger, Mujjahid Abbas & Leena Khaitan

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Drs. Alvarez, Youssef, Zadeh, Barger, and Anuja Sarode have no conflicts of interest or financial ties to disclose. Dr. Abbas serves as consultant for Intuitive Surgical, Inc. and Dr. Khaitan receives honoraria from Ethicon Inc., Medtronic, and W. L. Gore and Associates for teaching and advisory board roles and research support from Ethicon Inc.

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Alvarez, R., Youssef, J., Zadeh, J. et al. Sleeve gastrectomy morphology and long-term weight-loss and gastroesophageal reflux disease outcomes. Surg Endosc 37, 5652–5664 (2023). https://doi.org/10.1007/s00464-022-09555-6

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