Gastroesophageal Reflux After Sleeve Gastrectomy
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REVIEW ARTICLE
Gastroesophageal Reflux After Sleeve Gastrectomy Francisco A. Guzman-Pruneda 1
&
Stacy A. Brethauer 1
Received: 14 May 2020 / Accepted: 3 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Sleeve gastrectomy continues to be the most commonly performed bariatric operation worldwide. Development or worsening of pre-existing GERD has been recognized as a significant issue postoperatively. There is a paucity of information concerning the most appropriate preoperative workup and the technical and anatomical factors that may or may not contribute to the occurrence of reflux symptoms. Contemporary data quality is deficient given the predominantly retrospective nature, limited follow-up time, and heterogeneous outcome measures across studies. This has produced mixed results regarding the postoperative incidence and severity of GERD. Ultimately, better-constructed investigations are needed in order to offer evidence-based recommendations that may guide preoperative workup and improved patient selection criteria. Keywords Sleeve gastrectomy . Bariatric . GERD . Reflux . Heartburn . Complication . Hiatal hernia
Rationale As of 2016, 1.9 billion adults were overweight, and 650 million were classified as obese worldwide. In the USA, this translates to a prevalence of about 42%, exacting an annual financial cost of 147 billion US dollars, and accounting for up 1 to 9 million outpatient-related office visits. –3 Currently, over 250,000 bariatric operations are performed annually in the USA with an increasing surgeon and patient preference towards laparoscopic sleeve gastrectomies (LSG). In 2018, LSG comprised over 60% of bariatric procedures in the 4 USA (Fig. 1). Recent randomized controlled trials have suggested no significant difference in excess weight loss between 5 LSG and gastric bypass (GB) at 5-year follow-up. , 6 However, the enthusiasm for a growing sleeve practice has been met with concerns of de novo or worsening gastroesophageal reflux disease (GERD) after the procedure. Presently, a joint statement from the American Society for Metabolic and Bariatric Surgery, Society of American Gastrointestinal and Endoscopic Surgeons, and the American Society for Gastrointestinal Endoscopy considers erosive esophagitis as a relative contraindication for sleeve gastrectomy. Although * Stacy A. Brethauer [email protected] 1
Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
obesity and other patient-related and environmental factors have been shown to be independently associated with a higher incidence of GERD, certain anatomic and physiologic alterations resulting from a sleeve gastrectomy are being recognized as potential etiologies of worsening, and in some studies 7 improvement, of reflux disease. –10 This has prompted discussion among the surgical community with regard to preoperative patient counseling, surgeons’ own preferences when offering a gastric bypass over a sleeve, intra
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