Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference
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ORIGINAL CONTRIBUTIONS
Gastroesophageal Reflux and Laparoscopic Sleeve Gastrectomy: Results of the First International Consensus Conference Ahmad Assalia 1
&
Michel Gagner 2,3 & Marius Nedelcu 4,5 & Almino C. Ramos 6 & David Nocca 7
Received: 15 April 2020 / Revised: 22 May 2020 / Accepted: 28 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Gastroesophageal reflux disease (GERD) is probably the main drawback of laparoscopic sleeve gastrectomy (LSG). Herein, we critically discuss the issue and report the results of the first international consensus conference held in Montpellier, France, during June 2019. Methods Fifty international bariatric experts from 25 countries convened for 2 days for interactive discussions, and to formulate the most relevant questions by electronically submitting 55 preliminary questions to panelists. Following the meeting, a final drafted questionnaire comprised of 41 questions was sent to all experts via e-mail. Results Forty-six experts responded (92%). Esophago-gastro-duodenoscopy was considered mandatory before (92%) and after (78%) surgery. No consensus was achieved as to time intervals after surgery and the role of specialized tests for GERD. Higher degrees of erosive esophagitis (94%) and Barrett’s esophagus (96%) were viewed as contra-indications for LSG. Roux-en-Y gastric bypass was recommended in postoperative patients with uncontrolled GERD and insufficient (84%) or sufficient (76%) weight loss and Barrett’s esophagus (78%). Hiatal hernia (HH) repair was deemed necessary even in asymptomatic patients without GERD (80% for large and 67% for small HH). LSG with fundoplication in patients with GERD was considered by 77.3% of panelists. Conclusions The importance of pre- and postoperative endoscopy has been emphasized. The role of specialized tests for GERD and the exact surveillance programs need to be further defined. LSG is viewed as contra-indicated in higher degrees of endoscopic and clinical GERD. LSG with anti-reflux fundoplication emerges as a new valid option in patients with GERD. Keywords Consensus meeting . Gastroesophageal reflux . Sleeve gastrectomy
Introduction Laparoscopic sleeve gastrectomy (LSG) has become the most prevalent bariatric procedure performed in the USA [1] and worldwide [2, 3]. This rapid adoption is the result of the
* Ahmad Assalia [email protected]; [email protected] Michel Gagner [email protected] Marius Nedelcu [email protected] Almino C. Ramos [email protected] David Nocca [email protected] Extended author information available on the last page of the article
simplicity of the procedure, and comparable mid- to longterm results with laparoscopic Roux-en-Y gastric bypass (RYGB) with regard to sustained weight loss, improvement and resolution of co-morbidities, procedure-related morbidity, and quality of life [4–8]. However, one of the most controversial issues, considered as the LSG heel of Achilles by some, is the possible development of de novo or worsening of existi
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