A Step in the Right Direction: Trends over Time in Bariatric Procedures for Patients with Gastroesophageal Reflux Diseas
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ORIGINAL CONTRIBUTIONS
A Step in the Right Direction: Trends over Time in Bariatric Procedures for Patients with Gastroesophageal Reflux Disease Zaina Naeem 1 & Jie Yang 2 & Jihye Park 2 & Junying Wang 2 & Salvatore Docimo 1 & Aurora D. Pryor 1 & Konstantinos Spaniolas 1 Received: 25 March 2020 / Revised: 8 June 2020 / Accepted: 9 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction While laparoscopic sleeve gastrectomy (LSG) has recently emerged as the predominant surgery type for the national bariatric cohort, the literature suggests that laparoscopic Roux-en-Y gastric bypass (LRYGB) may be more effective in normalizing gastroesophageal physiology for the subset of patients with GERD. This study explored practice patterns over time for patients with GERD or hiatal hernia, a related comorbidity, undergoing bariatric surgery. Methods Data for LSG and LRYGB were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) datasets for 2015–2018. Multivariable logistic regression analyses were performed to determine the effects of pre-existing GERD or concomitant hiatal hernia repair on surgery type. Results A total of 130,772 patients underwent LRYGB (30.5%) or LSG (69.5%) in 2015, which increased year-to-year to 161,275 patients in 2018 (74.61% LSG). A total of 38.4% LRYGB patients had pre-existing GERD vs. 27.55% LSG patients. Patients with pre-existing GERD were increasingly likely to undergo LRYGB vs. those without GERD (OR 1.205 [95% CI 1.17–1.24] in 2015 vs. OR 1.510 [95% CI 1.47–1.55] in 2018, p < 0.0001 across years). Concomitant hiatal hernia repair was less common among LRYGB patients across all years (OR 0.413 [95% CI 0.4–0.43] for 2015; OR 0.381 [95% CI 0.37–0.4] for 2016; OR 0.403 [95% CI 0.39–0.42] for 2017, OR 0.464 [95% CI 0.45–0.48] for 2018, p < 0.0001). Discussion Bariatric patients with pre-existing GERD are increasingly likely to undergo LRYGB, consistent with the literature. LSG is presently more common in the overall cohort and among those undergoing concomitant hiatal hernia repair. Despite the growing recognition of GERD in bariatric patients, a significant discrepancy persists in hiatal hernia management per bariatric procedure type. Keywords Hiatal hernia . Gastroesophageal reflux disease . Bariatric surgery . Sleeve gastrectomy . Roux-en-Y gastric bypass . Obesity . Morbid obesity . Comorbidities . Esophageal . Gastric . Laparoscopic . Weight loss
Introduction Adult obesity rates in the USA have continued to steadily rise over the past two decades, reaching a prevalence of 42.4% in
This paper was presented in part at ObesityWeek 2018 in Nashville, TN, November 11–15, 2018. * Konstantinos Spaniolas [email protected] 1
Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Health Sciences Center T18-040, Stony Brook University, Stony Brook, NY 11794-8191, USA
2
Department of Applied Mathematics
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