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Sleeve gastrectomy and anti-reflux procedures

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Abstract

Background

Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem.

Methods

We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy.

Results

We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication.

Conclusion

A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.

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Funding

Funding for this study was provided by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center and the Foundation for Surgical Fellows.

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Authors and Affiliations

  1. College of Medicine, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198-5520, USA

    Kyle Gibbens

  2. Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA

    Christopher Crawford, Daniel Lomelin, Crystal Krause, Anton Simorov & Dmitry Oleynikov

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  1. Christopher Crawford
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  2. Kyle Gibbens
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Correspondence to Dmitry Oleynikov.

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Christopher Crawford, Kyle Gibbens, Daniel Lomelin, Crystal Krause, Anton Simorov, and Dmitry Oleynikov have no conflicts of interest or financial ties to disclose.

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Crawford, C., Gibbens, K., Lomelin, D. et al. Sleeve gastrectomy and anti-reflux procedures. Surg Endosc 31, 1012–1021 (2017). https://doi.org/10.1007/s00464-016-5092-6

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