De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux.

Borbély, Yves Michael; Schaffner, E; Zimmermann, Lara; Huguenin, Michael; Plitzko, Gabriel Andreas; Nett, Philipp C.; Kröll, Dino (2019). De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux. Surgical endoscopy, 33(3), pp. 789-793. Springer-Verlag 10.1007/s00464-018-6344-4

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BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed bariatric procedure to date. However, LSG is known to worsen pre-operative and result in de novo gastroesophageal reflux disease (GERD). Pre-operative evaluation reveals a high percentage of silent GERD of so far unknown influence on post-operative GERD. METHODS Prospective data of patients undergoing primary LSG between 01/2012 and 12/2015 were evaluated. Pre-operative GERD-specific evaluation consisted of validated questionnaires, upper endoscopy, 24 h-pH-manometry, and esophagograms. Patients were followed-up with questionnaires every 6 months, upper endoscopies after 1 year and 24 h-pH-metry after 2 years. Silent GERD was defined as esophagitis grade > B and/or abnormal esophageal acid exposure in absence of symptoms. LSG was performed over a 32F bougie, hiatal hernias > 1 cm were addressed with posterior hiatoplasty. Excluded were patients with hiatal hernias > 4 cm, patients with incorrect anatomy (stenosis, fundus too large) and conversion to RYGB for early leaks. RESULTS 222 patients were included. Mean follow-up was 32 ± 16 months, mean preoperative body mass index 49.6 ± 7.2 kg/m. 116 patients (52%) presented with post-operative GERD-symptoms, of which 85 (73%) had de novo symptoms. Of those, 48 (of 85, 56%) had no preoperative GERD and 37 (of 85, 44%) silent GERD. 57 patients (26%) had neither pre- nor post-operative GERD, 7 (3%) had silent pre-operative and no postop GERD, and in 19 patients (9%) GERD was cured with LSG. 31 patients (14%) stayed symptomatic. Of 56 patients (25%) with pre-operative silent GERD, 37 (of 54, 66%) became symptomatic. CONCLUSION LSG leads to a considerable rate of post-operative GERD. De novo-GERD consist of around half of pre-operative silent GERD and completely de novo-GERD. Most patients with pre-operative silent GERD became symptomatic.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Borbély, Yves Michael; Plitzko, Gabriel Andreas; Nett, Philipp C. and Kröll, Dino

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0930-2794

Publisher:

Springer-Verlag

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

25 Apr 2019 11:13

Last Modified:

25 Apr 2019 11:13

Publisher DOI:

10.1007/s00464-018-6344-4

PubMed ID:

30003346

Uncontrolled Keywords:

24-h pH-monitoring Asymptomatic diseases Body mass index Gastroesophageal reflux disease Obesity Sleeve gastrectomy

BORIS DOI:

10.7892/boris.125790

URI:

https://boris.unibe.ch/id/eprint/125790

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