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

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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.

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References

  1. Monkhouse SJ, Morgan JD, Bates SE, et al. An Overview of the Management of Morbid Obesity. Postgrad Med J. 2009;85:678–81.

    Article  PubMed  CAS  Google Scholar 

  2. Moy J, Pomp A, Dakin G, et al. Laparoscopic Sleeve Gastrectomy for Morbid Obesity. Am J Surg. 2008;196:56–9.

    Article  Google Scholar 

  3. Kolotkin RL, Zeller M, Modi AC, et al. Assessing Weight-Related Quality of Life in Adolescents. Obesity (Silver Spring). 2006;14:448–57.

    Article  Google Scholar 

  4. Moayyedi P. The Epidemiology of Obesity and Gastrointestinal and Other Diseases: An Overview. Dig Dis Sci. 2008;53:2293–9.

    Article  PubMed  Google Scholar 

  5. El-Serag H. The Association Between Obesity and GERD: A Review of the Epidemiological Evidence. Dig Dis Sci. 2008;53:2307–12.

    Article  PubMed  Google Scholar 

  6. Schneider JH, Küper M, Königsrainer A, et al. Transient Lower Esophageal Sphincter Relaxation in Morbid Obesity. Obes Surg. 2009;19:595–600.

    Article  PubMed  CAS  Google Scholar 

  7. Barak N, Ehrenpreis ED, Harrison JR, et al. Gastro-Oesophageal Reflux Disease in Obesity: Pathophysiological and Therapeutic Considerations. Obes Rev. 2002;3:9–15.

    Article  PubMed  CAS  Google Scholar 

  8. Schneider JM, Brücher BL, Küper M, et al. Multichannel Intraluminal Impedance Measurement of Gastroesophageal Reflux in Patients with Different Stages of Morbid Obesity. Obes Surg. 2009;19:1522–9.

    Article  PubMed  Google Scholar 

  9. Sugerman H, Windsor A, Bessos M, et al. Effects of Surgically Induced Weight Loss on Urinary Bladder Pressure, Sagittal Abdominal Diameter and Obesity co-Morbidity. Int J Obes Relat Metab Disord. 1998;22:230–5.

    Article  PubMed  CAS  Google Scholar 

  10. Ockander L, Hedenbro JL, Rehfeld JF, et al. Jejunoileal Bypass Changes the Duodenal Cholecystokinin and Somatostatin Cell Density. Obes Surg. 2003;13:584–90.

    Article  PubMed  Google Scholar 

  11. De Luca M, Segato G, Busetto L, et al. Progress in Implantable Gastric Stimulation: Summary of Results of the European Multi-Center Study. Obes Surg. 2004;14:33–9.

    Article  Google Scholar 

  12. Holterman AX, Browne A, Tussing L, et al. A Prospective Trial for Laparoscopic Adjustable Gastric Banding in Morbidly Obese Adolescents: An Interim Report of Weight Loss, Metabolic and Quality of Life Outcomes. J Pediatr Surg. 2010;45:74–8.

    Article  PubMed  Google Scholar 

  13. Sugerman HJ, Kellum JM, Engle KM, et al. Gastric Bypass for Treating Severe Obesity. Am J Clin Nutr. 1992;55:560–6.

    Google Scholar 

  14. Marceau P, Marceau S, Biron S, et al. Long-Term Experience with Duodenal Switch in Adolescents. Obes Surg. 2010;20:1609–16.

    Article  PubMed  Google Scholar 

  15. Katz PO, Menin RA, Gideon RM. Utility and Standards in Esophageal Manometry. J Clin Gastroenterol. 2008;42:620–6.

    Article  PubMed  Google Scholar 

  16. Schneider JH, Crookes PF, Becker HD. Four-Channel Sleeve Catheter for Prolonged Measurement of Lower Esophageal Sphincter Pressure. Dig Dis Sci. 1999;44:2456–61.

    Article  PubMed  CAS  Google Scholar 

  17. Abu-Jaish W, Rosenthal RJ. Sleeve Gastrectomy: A new Surgical Approach for Morbid Obesity. Expert Rev Gastroenterol Hepatol. 2010;4:101–19.

    Article  PubMed  Google Scholar 

  18. Iannelli A, Dainese R, Piche T, et al. Laparoscopic Sleeve Gastrectomy for Morbid Obesity. World J Gastroenterol. 2008;14:821–7.

    Article  PubMed  Google Scholar 

  19. Kueper MA, Kramer KM, Kirschniak A, et al. Laparoscopic Sleeve Gastrectomy: Standardized Technique of a Potential Stand-Alone Bariatric Procedure in Morbidly Obese Patients. World J Surg. 2008;32:1462–5.

    Article  PubMed  Google Scholar 

  20. Gagner M, Deitel M, Kalberer TL, et al. The Second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5:476–85.

    Article  PubMed  Google Scholar 

  21. Lalor PF, Tucker ON, Szomstein S, et al. Complications after Laparoscopic Sleeve Gastrectomy. Surg Obes Relat Dis. 2008;4:33–8.

    Article  PubMed  Google Scholar 

  22. Saber AA, El-Ghazaly TH. Early Experience with SILS Port Laparoscopic Sleeve Gastrectomy. Surg Laparosc Endosc Percutan Tech. 2009;19:428–30.

    Article  PubMed  Google Scholar 

  23. Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.

    Article  PubMed  Google Scholar 

  24. Hüttl TP, Obeidat FW, Parhofer KG, et al. Operative Techniques and Outcomes in Metabolic Surgery: Sleeve Gastrectomy. Zentralbl Chir. 2009;134:24–31.

    Article  PubMed  Google Scholar 

  25. Magee CJ, Barry J, Arumugasamy M, et al. Laparoscopic Sleeve Gastrectomy for High-Risk Patients: Weight Loss and Comorbidity Improvement—Short-Term Results. Obes Surg. 2010;21:547–50.

    Article  Google Scholar 

  26. Diamantis T, Alexandrou A, Nikiteas N, et al. Initial Experience with Robotic Sleeve Gastrectomy for Morbid Obesity. Obes Surg. 2010;21:1172–9.

    Article  Google Scholar 

  27. Jaffin BW, Knoepflmacher P, Greenstein R. High Prevalence of Asymptomatic Esophageal Motility Disorders among Morbidly Obese Patients. Obes Surg. 1999;9:390–5.

    Article  PubMed  CAS  Google Scholar 

  28. Klaus A, Gruber I, Wetscher G, et al. Prevalent Esophageal Body Motility Disorders Underlie Aggravation of GERD Symptoms in Morbidly Obese Patients following Adjustable Gastric Banding. Arch Surg. 2006;141:247–51.

    Article  PubMed  Google Scholar 

  29. Suter M, Dorta G, Giusti V, et al. Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients. Obes Surg. 2004;14:959–66.

    Article  PubMed  CAS  Google Scholar 

  30. Bredenoord AJ, Smout AJ. Esophageal Motility Testing: Impedance-Based Transit Measurement and High-Resolution Manometry. Gastroenterol Clin North Am. 2008;37:775–91.

    Article  PubMed  Google Scholar 

  31. Fass J, Silny J, Braun J, et al. Measuring Esophageal Motility with a new Intraluminal Impedance Device. First Clinical Results in Reflux Patients. Scand J Gastroenterol. 1994;29:693–702.

    Article  PubMed  CAS  Google Scholar 

  32. Himpens J, Dobbeleir J, Peeters G. Long-Term Results of Laparoscopic Sleeve Gastrectomy for Obesity. Ann Surg. 2010;252:319–24.

    Article  PubMed  Google Scholar 

  33. Chiu S, Birch DW, Shi X, et al. Effect of Sleeve Gastrectomy on Gastroesophageal Reflux Disease: A Systematic Review. Surg Obes Relat Dis. 2010;7:510–5.

    Article  PubMed  Google Scholar 

  34. Liebermann-Meffert D, Allgöwer M, Schmid P, et al. Muscular Equivalent of the Lower Esophageal Sphincter. Gastroenterology. 1979;76:31–8.

    PubMed  CAS  Google Scholar 

  35. Stein HJ, Liebermann-Meffert D, DeMeester TR, et al. Three-Dimensional Pressure Image and Muscular Structure of the Human Lower Esophageal Sphincter. Surgery. 1995;117:692–8.

    Article  PubMed  CAS  Google Scholar 

Download references

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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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany

    Wiebke V. Petersen, Tobias Meile, Markus A. Küper, Marty Zdichavsky, Alfred Königsrainer & Joachim H. Schneider

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  1. Wiebke V. Petersen
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  2. Tobias Meile
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  3. Markus A. Küper
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  4. Marty Zdichavsky
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  6. Joachim H. Schneider
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Correspondence to Joachim H. Schneider.

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Petersen, W.V., Meile, T., Küper, M.A. et al. Functional Importance of Laparoscopic Sleeve Gastrectomy for the Lower Esophageal Sphincter in Patients with Morbid Obesity. OBES SURG 22, 360–366 (2012). https://doi.org/10.1007/s11695-011-0536-5

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