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Obesity Surgery

, Volume 22, Issue 3, pp 360–366 | Cite as

Functional Importance of Laparoscopic Sleeve Gastrectomy for the Lower Esophageal Sphincter in Patients with Morbid Obesity

  • Wiebke V. Petersen
  • Tobias Meile
  • Markus A. Küper
  • Marty Zdichavsky
  • Alfred Königsrainer
  • Joachim H. Schneider
Clinical Research

Abstract

Background

Obesity is characterized by excess body fat measured in body mass index (BMI), which is the weight in kilograms (kg) divided by the height in square meters [m2]. In the Northern Hemisphere, the prevalence of overweight has increased by up to 34%. This situation is associated with high incidence of comorbidities such as gastroesophageal reflux disease. Bariatric surgery is the only effective treatment for severe obesity, resulting in amelioration of obesity comorbidities. Data on LES competence following sleeve gastrectomy (SG), one of the several bariatric procedures, are conflicting.

Methods

In a prospective study, we enrolled 37 patients and divided them into two subgroups in order to evaluate lower esophageal sphincter pressure (LESP) and esophageal motility before and after laparoscopic sleeve gastrectomy (LSG) by means of stationary esophageal manometry. A study collective also underwent a gastroscopy. Participants (20) were healthy controls who volunteered.

Results

Preoperative median BMI in group I (control) differed statistically significantly (p < 0.0001) as compared to groups II and III (22 vs. 50.5 or 47.5 kg/m², respectively). After LSG, the BMI of groups II and III decreased to 39.5 and 45 kg/m², respectively. Postoperatively, LESP increased significantly, namely, from preoperative 8.4 to 21.2 mmHg in group II and from 11 to 24 mmHg (p < 0.0001) in group III. Tubular esophageal motility profits from LSG. As expected, the gastroscopy findings ranged from cardiac insufficiency, esophagitis and hiatal hernia to gastric ulcer.

Conclusion

LSG significantly increased lower esophageal pressure independent of weight loss after LSG and may protect obese patients from gastroesophageal reflux.

Keywords

Morbid obesity Laparoscopic sleeve gastrectomy Lower esophageal sphincter pressure 

Notes

Conflict of Interest Statement

Grant funding and support for travel to meetings were provided to the authors in the Department of General, Visceral and Transplant Surgery, University of Tübingen, by the German Federal Ministry of Education and Research.

None of the authors have any other conflict of interest.

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Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Wiebke V. Petersen
    • 1
  • Tobias Meile
    • 1
  • Markus A. Küper
    • 1
  • Marty Zdichavsky
    • 1
  • Alfred Königsrainer
    • 1
  • Joachim H. Schneider
    • 1
  1. 1.Department of General, Visceral and Transplant SurgeryUniversity of TübingenTübingenGermany

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