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The Effect of Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease in the Morbidly Obese

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An Erratum to this article was published on 21 September 2015

Abstract

Background

The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG.

Methods

A single institution, multi-surgeon, prospectively maintained database was examined to identify patients who underwent LSG and concomitant HHR from December 2010 to October 2013. Patient characteristics, operative details, and postoperative outcomes were analyzed. Standardized patient questionnaires administered both pre- and postoperatively were utilized. Primary endpoints included subjective reflux symptoms and the need for antisecretory therapy. Weight loss was considered a secondary endpoint.

Results

Fifty-eight patients were identified meeting inclusion criteria (LSG + HHR), with a mean follow-up of 97.5 weeks (range 44–172 weeks). The mean age of the cohort was 49.5 ± 11.2 years, with 74.1 % being female. Mean preoperative BMI was 44.2 ± 6.6 kg/m2. Preoperative upper gastrointestinal contrast series was performed in all patients and demonstrated a hiatal hernia in 34.5 % of patients and reflux in 15.5 % of patients. Preoperatively, 34.6 % (n = 26) of patients reported subjective symptoms of reflux and/or required daily antisecretory therapy. After LSG + HHR, 34.6 % of symptomatic patients had resolution of their symptoms off therapy while the rest remained symptomatic and required daily antisecretory therapy; 84.4 % of patients that were asymptomatic preoperatively remained asymptomatic after surgery. New onset reflux symptoms requiring daily antisecretory therapy was seen in 15.6 % of patients who were previously asymptomatic. Post surgical weight loss did not correlate with the presence or resolution of reflux symptoms.

Conclusion

Based on our data, LSG with concomitant HHR improved GERD symptoms or the need for daily antisecretory therapy only in a third of symptomatic patients. Furthermore, 15.6 % of asymptomatic patients developed de novo GERD symptoms despite a HHR. In patients with a documented hiatal hernia, HHR does not lead to GERD resolution or prevention after LSG, indicating the need for appropriate patient counseling and further study.

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References

  1. El-Seraq HB, Graham DY, Satia JA, et al. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243–50.

    Article  Google Scholar 

  2. Corley DA, Kubo A. Body mass index and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Gastroenterol. 2006;101:2619–28.

    Article  PubMed  Google Scholar 

  3. 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 

  4. Wajed SA, Streets CG, Bremner CG, et al. Elevated body mass disrupts the barrier to gastroesophageal reflux. Arch Surg. 2001;136:1014–8.

    Article  PubMed  CAS  Google Scholar 

  5. De Vires DR, Van Herwaarden MA, Smout AJ, et al. Gastroesophageal pressure gradients in gastroesophageal reflux disease: relations with hiatal hernia, body mass index and esophageal acid exposure. Am J Gastroenterol. 2008;103:1349–54.

    Article  Google Scholar 

  6. Pallati PK, Shaligram A, Shostrom VK, et al. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2013;13:259–1.

    Google Scholar 

  7. Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15(9):986–9.

    Article  PubMed  CAS  Google Scholar 

  8. Chiu S, Birch DW, 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 

  9. Gorodner V, Buxhoeveden R, Clemente G, et al. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surg Endosc 2014.

  10. 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 

  11. 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(3):357–62.

    Article  PubMed  Google Scholar 

  12. Burgerhart JS, Schotborgh CA, Schoon EJ, et al. Effect of sleeve gastrectomy on gastroesophageal reflux. Obes Surg. 2014;24(9):1436–41.

    Article  PubMed  Google Scholar 

  13. Daes J, Jimenez ME, Said N, et al. Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique. Obes Surg. 2012;22(12):1874–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Soricelli E, Iossa A, Casella G, et al. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis. 2013;9:356–62.

    Article  PubMed  Google Scholar 

  15. Braghetto I, Csendes A, Lanzarini E, et al. Is laparoscopic sleeve gastrectomy an acceptable primary bariatric procedure in obese patients? Early and 5-year postoperative results. Surg Laparosc Endosc Percutan Tech. 2012;22(6):479–86.

    Article  PubMed  Google Scholar 

  16. 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 

  17. Laffin M, Chau J, Gill RS, et al. Sleeve gastrectomy and gastroesophageal reflux disease. J Obes. 2013;741097. Epub 2013 Jul 15.

  18. Howard DD, Caban AM, Cendan JC, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Surg Obes Relat Dis. 2011;7:709–13.

    Article  PubMed  Google Scholar 

  19. Tai CM, Huang CK, Lee YC, et al. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults. Surg Endosc. 2013;27:1260–6.

    Article  PubMed  Google Scholar 

  20. Carter PR, LeBlank KA, Hausmann MG, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2011;7:569–74.

    Article  PubMed  Google Scholar 

  21. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20(6):859–63.

    Article  PubMed  CAS  Google Scholar 

  22. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5.

    Article  PubMed  CAS  Google Scholar 

  23. Hamoui N, Anthone GJ, Kaufman HS, et al. Sleeve gastrectomy in the high-risk patient. Obes Surg. 2006;16(110):1445–9.

    Article  PubMed  Google Scholar 

  24. Fornari F, Gurski RR, Navarini D, et al. Clinical utility of endoscopy and barium swallow x-ray in the diagnosis of sliding hiatal hernia in morbidly obese patients: a study before and after gastric bypass. Obes Surg. 2010;20:702–8.

    Article  PubMed  Google Scholar 

  25. Townsend CM, Beauchamp RD, Evers BM, et al., editors. Sabiston textbook of surgery. 19th ed. New York: Elsevier Saunders; 2012.

    Google Scholar 

  26. Peteresen WV, Meile T, Kuper MA, et al. Functional importance of laparoscopic sleeve gastrectomy for the lower esophageal sphincter in patients with morbid obesity. Obes Surg. 2012;22(3):360–6.

    Article  Google Scholar 

  27. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.

    Article  PubMed  Google Scholar 

  28. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16(11):1450–6.

    Article  PubMed  Google Scholar 

  29. Nahata M, Muto S, Oridate N, et al. Impaired ghrelin signaling is associated with gastrointestinal dysmotility in rats with gastroesophageal reflux disease. Am J Physiol Gastrointest Liver Physiol. 2012;303(1):G42–53.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. Santonicola A, Angrisani L, Cutolo P, et al. The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients. Surg Obes Relat Dis. 2014;10:250–6.

    Article  PubMed  Google Scholar 

  31. Ardestani A, Tavakkoli A. Hiatal hernia repair and gastroesophageal reflux disease in gastric banding patients: analysis of a national database. Surg Obes Relat Dis. 2014;10:438–44.

    Article  PubMed  Google Scholar 

  32. Che F, Nguyen B, Cohen A, et al. Prevalence of hiatal hernia in the morbidy obese. Surg Obes Relat Dis. 2013;9(6):920–4.

    Article  PubMed  Google Scholar 

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Funding

None

Conflict of Interest

The authors declare that they have no competing interest.

Ethical Approval

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

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of General Surgery, Loma Linda University Medical Center, Coleman Pavilion 21111, 11175 Campus Street, Loma Linda, CA, 92350, USA

    Kamran Samakar

  2. Department of General Surgery, Mayo Clinic, Rochester, MN, USA

    Travis J. McKenzie

  3. Department of General and GI Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Ali Tavakkoli, Ashley H. Vernon, Malcolm K. Robinson & Scott A. Shikora

Authors
  1. Kamran Samakar
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  2. Travis J. McKenzie
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  3. Ali Tavakkoli
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  6. Scott A. Shikora
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Correspondence to Kamran Samakar.

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Samakar, K., McKenzie, T.J., Tavakkoli, A. et al. The Effect of Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease in the Morbidly Obese. OBES SURG 26, 61–66 (2016). https://doi.org/10.1007/s11695-015-1737-0

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  • DOI: https://doi.org/10.1007/s11695-015-1737-0

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