Laparoscopic Sleeve Gastrectomy: Symptoms of Gastroesophageal Reflux can be Reduced by Changes in Surgical Technique

BACKGROUND Bariatric surgery is the most effective treatment for gastro-esophageal reflux disease (GERD) in obese patients, with the Roux-en-Y gastric bypass being the technique preferred by many surgeons. Published data reporting the results of laparoscopic sleeve gastrectomy (LSG) in patients with GERD are contradictory. In a previous observational study, we found that relative narrowing of the distal sleeve, hiatal hernia (HH), and dilation of the fundus predispose to GERD after LSG. In this study, we evaluated the effects of standardization of our LSG technique on the incidence of postoperative symptoms of GERD. METHODS This was a concurrent cohort study. Patients who underwent bariatric surgery at our center were followed prospectively. LSG was performed in all patients in this series. RESULTS A total of 234 patients underwent surgery. There were no cases of death, fistula, or conversion to open surgery. All 134 patients who completed 6-12 months of postoperative follow-up were evaluated. Excess weight loss at 1 year was 73.5%. In the study group, 66 patients (49.2%) were diagnosed with GERD preoperatively, and HH was detected in 34 patients (25.3%) intraoperatively. HH was treated by reduction in three patients, anterior repair in 28, and posterior repair in three. Only two patients (1.5%) had symptoms of GERD at 6-12 months postoperatively. CONCLUSIONS Our results confirm that careful attention to surgical technique can result in significantly reduced occurrence of symptoms of GERD up to 12 months postoperatively, compared with previous reports of LSG in the literature.