Sleeve Gastrectomy and GERD
Jeremiah Hyslip, Thuy Duong Doan, Nicole Cherng, Richard Perugini
University of Massachusetts Medical School, Worcester, Massachusetts, United States
Objective: Longitudinal sleeve gastrectomy (LSG) has become the most performed bariatric operation. This procedure appears less effective at resolving gastroesophageal reflux disease (GERD) and may even lead to de novo GERD. We studied the impact of LSG on both the development and resolution of GERD. Design: Retrospective cohort study. Setting: UMass Memorial Medical Center; division of bariatric surgery. Patients: There were 174 patients who underwent LSG at UMass Memorial in 2019. Interventions: N/A. Main Outcome Measures: GERD was defined as presence in the medical history with or without acid suppression therapy. We assessed factors predictive of problematic postoperative GERD, as well as management and natural history. Incidences of GERD development and remission at 6 months post-op were calculated. Results: In the 54 patients with preexisting GERD, 20 (37.0%) demonstrated GERD resolution six months postoperatively. Of the 120 patients without preexisting GERD, 17 (14.1%) developed GERD six months postoperatively. Of 67 patients who had lingering or de novo GERD postoperatively, 19 (28.4%) experienced a reduction in their medication regimen. Of the 29 patients who still required PPIs six months postoperatively, 13 (44.8%) had structural abnormalities, including 9 (31.0%) with a hiatal hernia (HH). The association between GERD requiring PPIs and concurrent HH was significant (p=0.04). Conclusions: LSG has a beneficial impact on GERD, leading to resolution in 37% of patients. Patients with refractory GERD should be evaluated for a HH or other structural anomaly, which are potentially amenable to intervention. More research is needed to elucidate whether more intensive preoperative screening or alterations in surgical technique can improve GERD rates post-LSG.
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