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Rates of Reflux Before and After Laparoscopic Sleeve Gastrectomy for Severe Obesity

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Abstract

Background

A current management dilemma in laparoscopic sleeve gastrectomy (LSG) patients is the development of significant gastroesophageal reflux symptoms after surgery. Treatment is typically directed towards reducing acid reflux despite the surgical removal of parietal cell mass. In contrast, laparoscopic Roux-en-Y gastric bypass (LRYGB) has been known to reduce or resolve preoperative reflux symptoms. The objective of this study was to determine the incidence of preoperative and postoperative reflux of LSG and LRYGB patients, and review reflux treatment type and response.

Methods

A retrospective chart review was performed for patients undergoing either LSG or LRYGB between January 2010 and December 2012 as part of the Weight Wise program, Royal Alexandra Hospital, Edmonton, Canada.

Results

A total of 387 cases were included in our review. We observed a significant reduction in BMI postoperatively for both LSG and LRYGB groups (p < 0.001). Between surgical groups, preoperative proton-pump inhibitor (PPI) use was not significantly different; however, at 1 month (p < 0.05) to 1–2 years (p < 0.001), there was significantly increased PPI use in patients after LSG in comparison to LRYGB. Of the LSG patients that continued their PPI treatment after surgery, 58 % increased, 42 % continued the same, and 0 % decreased their dose 1 year after surgery.

Conclusions

Reflux symptoms are significantly increased after LSG in comparison to LRYGB patients. In addition, LSG patients more frequently require initiation of reflux treatment after surgery than that of LRYGB patients. Patients reported postoperative reflux symptom relief with acid-suppressant therapies.

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References

  1. Todkar J, Shah S, Shah P, et al. Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6:142–5.

    Article  PubMed  Google Scholar 

  2. Snyder-Marlow G, Taylor D, Lenhard J. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. Am Diet Assoc. 2010;110(4):600–7.

    Article  Google Scholar 

  3. Roa P, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.

    Article  PubMed  Google Scholar 

  4. Jacobs M, Bisland W, Gomez E, et al. Laparoscopic sleeve gastrectomy: a retrospective review of 1- and 2-year results. Surg Endosc. 2010;24:781–5.

    Article  PubMed  Google Scholar 

  5. Lakdawala M, Bhasker A, Mulchandani D, et al. 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. 2010;20:1–6.

    Article  PubMed  Google Scholar 

  6. Weiner R, Weiner S, Pomhoff I, et al. Laparoscopic sleeve gastrectomy—influence of sleeve size and resected gastric volume. Obes Surg. 2007;17:1297–305.

    Article  PubMed  Google Scholar 

  7. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17(1):57–62.

    Article  PubMed  Google Scholar 

  8. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obesity Surgery. 2008;18:560–5.

    Article  CAS  PubMed  Google Scholar 

  9. DuPree C, Blair K, Steele S, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surgery. 2014;February:E1-7.

  10. Madalosso C, Gurski R, Callegari-Jacques S, et al. The impact of gastric bypass on gastroesophageal reflux disease in patients with morbid obesity. Ann Surg. 2010;251(2):244–8.

    Article  PubMed  Google Scholar 

  11. Sarkhosh K, Birch D, Sharma A, et al. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Can J Surg. 2013;56(5):347–52.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Carabotti M, Silecchia G, Greco F, et al. Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg. 2013;23:1551–7.

    Article  PubMed  Google Scholar 

  13. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Obes Res. 1998;6(6):464.

    Article  Google Scholar 

  14. Tuckman B. Selecting a statistical test in: conducting educational research. 5th ed. Wadsworth: Harcourt Brace College Publishers; 1999. p. Table 37.1.

    Google Scholar 

  15. Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg. 2010;20:357–62.

    Article  PubMed  Google Scholar 

  16. Friedenberg F, Xanthopoulos M, Foster G, et al. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103(8):2111–22.

    Article  PubMed  Google Scholar 

  17. Carter P, LeBlanc K, Hausmann M, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:569–74.

    Article  PubMed  Google Scholar 

  18. Langer F, Hoda M, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.

    Article  CAS  PubMed  Google Scholar 

  19. Katz P, Gerson L, Vela M. Diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–2.

    Article  PubMed  Google Scholar 

  20. Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficacy, and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.

    Article  PubMed  Google Scholar 

  21. Herbella F, Vicentine F, Del Grande J, et al. Postprandial proximal gastric acid pocket and gastric pressure in patients after gastric surgery. Neurogastroenterol Mot. 2011;23:52–e4.

    Article  CAS  Google Scholar 

  22. Roslin M. Comment on: association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:572–4.

    Article  PubMed  Google Scholar 

  23. Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21:473–8.

    Article  PubMed  Google Scholar 

  24. Jacques Himpens M, Giovanni Dapri M, Guy Bernard C. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.

    Article  PubMed  Google Scholar 

  25. Chiu S, Birch D, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7:510–5.

    Article  PubMed  Google Scholar 

  26. Cottam D, Qureshi F, Mattar S, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.

    Article  CAS  PubMed  Google Scholar 

  27. Han S, Kim W, Oh J. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.

    Article  Google Scholar 

  28. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy. Ann Surg. 2013;257(2):231–7.

    Article  PubMed  Google Scholar 

  29. Rosenthal R, International Sleeve Gastrectomy Expert Panel. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.

    Article  PubMed  Google Scholar 

  30. Kohn G, Price R, Demeester S, et al. SAGES guidelines committee. Guidelines for the management of hiatal hernia. California: Society of American Gastrointestinal and Endoscopic Surgeons; 2013. Available from: http://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia/.

  31. Bohdjalian A, Langer F, Shakeri-Leidenmuhler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20:535–40.

    Article  PubMed  Google Scholar 

  32. Cremonini F, Ziogas D, Chang H, et al. Meta-analysis: the effects of placebo treatment on gastro-oesophageal reflux disease. Alimentary Pharmacol Therapy. 2010;32(1):29–42.

    Article  CAS  Google Scholar 

  33. Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg. 2014;24(1):71–7.

    Article  PubMed  Google Scholar 

  34. Peterli R, Borbely Y, Kern B, et al. Early results of the swiss multicentre bypass or sleeve study (SM-BOSS). Ann Surg. 2013;258(5):690–5.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Deitel M, Gagner M, Erickson A, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:749–5.

    Article  PubMed  Google Scholar 

  36. Crookes P. Physiology of reflux disease: role of the lower esophageal sphincter. Surg Endosc. 2006;20:S462–6.

    Article  PubMed  Google Scholar 

  37. Jacobsen S, Olesen S, Dirksen C, et al. Changes in gastrointestinal hormone responses, insulin sensitivity, and beta-cell function within 2 weeks after gastric bypass in non-diabetic subjects. Obes Surg. 2012;22:1084–96.

    Article  CAS  PubMed  Google Scholar 

  38. Laffin M, Chau J, Gill R, et al. Sleeve gastrectomy and gastroesophageal reflux disease. J Obes. 2013;1–6.

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Conflict of Interest

Authors Ms. Sheppard, Dr. Sadowski, and Dr. Karmali have no conflict of interest. Drs. de Gara and Birch have contributions from Ethicon Johnson & Johnson and Stryker in the manner of surgical equipment for resident training.

Statement of Consent

Informed consent was waived for all participants in the study as approved by the University of Alberta Human Research Ethics Board.

Statement of Human and Animal Rights

For this type of study (retrospective), formal consent is not required.

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Authors and Affiliations

  1. Centre for the Advancement of Minimally Invasive Surgery, Rm 502 Community Services Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada

    Caroline E. Sheppard, Shahzeer Karmali & Daniel W. Birch

  2. 2J2.00 WC Mackenzie Health Sciences Centre, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2R7, Canada

    Caroline E. Sheppard, Daniel C. Sadowski, Christopher J. de Gara, Shahzeer Karmali & Daniel W. Birch

  3. Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada

    Daniel C. Sadowski & Christopher J. de Gara

Authors
  1. Caroline E. Sheppard
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  2. Daniel C. Sadowski
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  3. Christopher J. de Gara
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  4. Shahzeer Karmali
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  5. Daniel W. Birch
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Correspondence to Daniel W. Birch.

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Sheppard, C.E., Sadowski, D.C., de Gara, C.J. et al. Rates of Reflux Before and After Laparoscopic Sleeve Gastrectomy for Severe Obesity. OBES SURG 25, 763–768 (2015). https://doi.org/10.1007/s11695-014-1480-y

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  • DOI: https://doi.org/10.1007/s11695-014-1480-y

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