Surgical Endoscopy

, Volume 32, Issue 5, pp 2373–2380 | Cite as

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

  • Philip Le Page
  • David Martin
  • Craig Taylor
  • Jennifer Wang
  • Himanshu Wadhawan
  • Gregory Falk
  • Simon C. Gibson
Article

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.

Keywords

Gastroesophageal reflux Obesity Bariatric surgery Laparoscopic sleeve gastrectomy 

Notes

Acknowledgements

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

Compliance with ethical standards

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.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Philip Le Page
    • 1
  • David Martin
    • 1
  • Craig Taylor
    • 1
  • Jennifer Wang
    • 1
  • Himanshu Wadhawan
    • 2
    • 3
  • Gregory Falk
    • 1
  • Simon C. Gibson
    • 1
    • 2
  1. 1.Concord Repatriation General HospitalConcordAustralia
  2. 2.Queen Elizabeth University HospitalGlasgowUK
  3. 3.Department of SurgeryQueen Elizabeth University HospitalGlasgowUK

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