Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
The effect of laparoscopic sleeve gastrectomy (SG) on the development of
gastroesophageal reflux disease (GERD) has remained controversial. Despite the positive
effect of sleeve gastrectomy (SG) on weight loss and improvement in obesity and its
morbidities, there is concern about the development of gastro esophageal reflux after this
bariatric operation. There have been limited studies on this aspect and most of
the published studies are retrospective. Therefore, we conducted a prospective study to
assess this problem.
OBJECTIVE:
The aim of study is to assess the incidence of GERD post LSG.
PATIENTS AND METHODS:
We studied the incidence of GERD in patients who underwent LSG for the treatment of
their morbid obesity at Al Imamain Al Kadhimain Teaching hospital. A prospective review
of 48 patients undergoing LSG for morbid obesity from the 1st of October 2016 to the 1st
of October 2018 was performed. Patients were evaluated using the Spanish version of
the Carlsson-Dent questionnaire. Evaluation was done at 1, 6 months and 1 year
postoperatively. Postoperative gastric anatomy was checked by Gastrografin studies that
were routinely performed in all patients on the third postoperative day. These studies were
evaluated prospectively. Changes of each one of the reflux symptoms were assessed in
relation to the radiological pattern of the gastric sleeve.
RESULTS:
We had two groups of patients. Both of them underwent LSG by the same surgical team
and in the same technique; the only difference between them was the point of start of
devascularization and cutting of the stomach. Group 1 included 27 patients in whom the
start of devascularization and cutting of the stomach was at 4 cm from the pylorus. Group
2 included 21 patients in whom devascularization and cutting of the stomach was at 6 cm
from the pylorus of stomach. GERD occurred in 9 patients in Group 1 which represent
(33.33 %). While 1 patient from Group 2 had GERD postoperatively and they represent
(4.76%).
CONCLUSION:
LSG might increase the occurrence of GERD despite the satisfactory weight loss.
The incidence of GERD can be reduced by changing the surgical technique. Additional
studies including esophageal manometry and 24-hours pH testing are needed to obtain
better evaluation on the effect of LSG on gastroesophageal reflux disease.