Sleeve Gastrectomy and Anterior Fundoplication (D-SLEEVE) Prevents Gastroesophageal Reflux in Symptomatic GERD
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ORIGINAL CONTRIBUTIONS
Sleeve Gastrectomy and Anterior Fundoplication (D-SLEEVE) Prevents Gastroesophageal Reflux in Symptomatic GERD Gianmattia del Genio 1 & Salvatore Tolone 1 & Claudio Gambardella 1 & Luigi Brusciano 1 & Mariachiara Lanza Volpe 1 & Giorgia Gualtieri 1 & Federica del Genio 1 & Ludovico Docimo 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background A worrying increase of gastroesophageal reflux disease (GERD) and Barrett esophagus has been reported after sleeve gastrectomy (SG). Recent reports on combined fundoplication and SG seem to accomplish initial favorable results. However, no study included manometry or pH monitoring to evaluate the impact of fundoplication in SG on esophageal physiology. Method In this study, 32 consecutive bariatric patients with GERD and/or esophagitis had high-resolution impedance manometry (HRiM) and combined 24-h pH and multichannel intraluminal impedance (MII-pH) before and after laparoscopic sleeve gastrectomy associated to anterior fundoplication (D-SLEEVE). The following parameters were calculated at HRiM: lower esophageal sphincter pressure and relaxation, peristalsis, and mean total bolus transit time. The acid and non-acid GER episodes were assessed by MII-pH, symptom index association (SI), and symptom-association probability (SAP) were also analyzed. Results At a median follow-up of 14 months, HRiM showed an increased LES function, and MII-pH showed an excellent control of both acid exposure of the esophagus and number of reflux events. Bariatric outcomes (BMI and EWL%) were also comparable to regular SG (p = NS). Conclusion D-SLEEVE is an effective restrictive procedure, which recreates a functional LES pressure able to control and/or prevent mild GERD at 1-year follow-up. Keywords Sleeve gastrectomy . GERD . HRiM . MII-pH . Anterior fundoplication
Introduction As for any other surgical procedure able to change anatomy of stomach, sleeve gastrectomy (SG) has an important impact on either gastric or esophageal function [1, 2]. Given the gastric fundus removal, partial section of the muscular collar Helvetius’s fibers [3], reduced volume, and increased pressure of the tube, SG has potential risk of promoting “de novo” postoperative reflux. Recently, some authors have reported a worrying increase of gastroesophageal reflux disease (GERD)
* Gianmattia del Genio [email protected] 1
Center of Esophago-gastric and Obesity Surgery (E.G.O.), XI Division and Bariatric Surgery, University Vanvitelli, Naples, Italy
and Barrett esophagus after SG [4–8] eventually associated to biliary duodenogastric refluate [9]. We recently observed that SG with a regular tube, preserving antrum and LES anatomy, does not induce “de novo” GERD in patients without preoperative evidence of pathological reflux [10]. However, concerns may rise in patients with preoperative GERD symptoms or clinical evidence of LES incompetence at preoperative instrumental assessment. In attempt to reduce postoperative risk of GERD symptoms and to expand our indication
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