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Trujillo AB, Sagar D, Amaravadhi AR, Muraleedharan D, Malik MZ, Effa-Ababio K, Nsengiyumva M, Tesfaye T, Walędziak M, Różańska-Walędziak A. Incidence of Post-operative Gastro-esophageal Reflux Disorder in Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-analysis. Obes Surg 2024; 34:1874-1884. [PMID: 38483740 DOI: 10.1007/s11695-024-07163-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
Gastroesophageal reflux disease (GERD) is a common concern following laparoscopic sleeve gastrectomy (LSG). This paper aimed to assess the incidence of reflux disease following these bariatric procedures. A literature search was conducted to identify observational studies and clinical trials reporting patients developed GERD disease after LSG. Twenty-two studies included in the analysis, involve 20,495 participants, indicated that the estimated proportion of patients who developed post-surgery GERD was 0.35 (95% CI 0.30-0.41). Subgroup analysis revealed a proportion of 0.33 (95% CI 0.27-0.38) in observational studies and 0.58 (95% CI 0.39-0.75) in clinical trials. High heterogeneity was noted across studies (I2 = 98%). Sensitivity analyses and publication bias assessments were performed to enhance the robustness of the results. Our findings highlight a moderate to high risk of developing GERD following LSG surgery.
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Affiliation(s)
| | - Drishti Sagar
- Aakash Healthcare Superspeciality Hospital, Sector-3, Dwarka, Delhi, 110075, India
| | - Amoolya Rao Amaravadhi
- Internal Medicine, Malla Reddy Institute of Medical Sciences, GHMC Quthbullapur, Jeedimetla, Hyderabad, 500055, India
| | | | | | - Kofi Effa-Ababio
- University of Texas MD Anderson Cancer Center, Holcombe Boulevard, Houston, TX, 77030-4009, USA
| | | | - Tadele Tesfaye
- CareHealth Medical Practice, Jimma Road, Addis Ababa, Ethiopia
| | - Maciej Walędziak
- Department of General, Oncologic, Metabolic, and Thoracic Surgery, Military Institute of Medicine - National Research Institute, 04-141, Warsaw, Poland.
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Patophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938, Warsaw, Poland
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Poggi Machuca L, Romani Pozo D, Guerrero Martinez H, Rojas Reyes R, Dávila Luna A, Cruz Condori D, Poggi L. Possible technical aspects involved in the development of GERD after sleeve gastrectomy: Surgical technique considerations. Cir Esp 2023; 101 Suppl 4:S43-S51. [PMID: 37979942 DOI: 10.1016/j.cireng.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 02/13/2023] [Indexed: 11/20/2023]
Abstract
Sleeve gastrectomy (SG) is the most common bariatric surgery worldwide and has shown to cause de novo or worsen symptoms of gastroesophageal reflux disease (GERD). Esophageal motility and physiology studies are mandatory in bariatric and foregut centers. The predisposing factors in post-SG patients are disruption of His angle, resection of gastric fold and gastric fundus, increased gastric pressure, resection of the gastric antrum, cutting of the sling fibers and pyloric spasm. There are symptomatic complications due to sleeve morphology as torsion, incisura angularis stenosis, kinking and dilated fundus. In this article, we present recommendations, surgical technique and patient selection flow diagram for SG and avoid de novo or worsening GERD.
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Affiliation(s)
- Luis Poggi Machuca
- Departamento de Cirugía General y Laparoscópica, Clínica Anglo Americana, Lima, Peru; Laboratorio de Neurogastro Motilidad, Centro de Investigación de Fisiología y Cirugía del Aparato Digestivo, Lima, Peru
| | - Diego Romani Pozo
- Departamento de Cirugía General y Laparoscópica, Clínica Anglo Americana, Lima, Peru; Laboratorio de Neurogastro Motilidad, Centro de Investigación de Fisiología y Cirugía del Aparato Digestivo, Lima, Peru.
| | - Harold Guerrero Martinez
- Departamento de Cirugía General y Laparoscópica, Clínica Anglo Americana, Lima, Peru; Laboratorio de Neurogastro Motilidad, Centro de Investigación de Fisiología y Cirugía del Aparato Digestivo, Lima, Peru
| | - Rodrigo Rojas Reyes
- Departamento de Cirugía General y Laparoscópica, Clínica Anglo Americana, Lima, Peru; Laboratorio de Neurogastro Motilidad, Centro de Investigación de Fisiología y Cirugía del Aparato Digestivo, Lima, Peru
| | - Andrea Dávila Luna
- Departamento de Cirugía General y Laparoscópica, Clínica Anglo Americana, Lima, Peru; Laboratorio de Neurogastro Motilidad, Centro de Investigación de Fisiología y Cirugía del Aparato Digestivo, Lima, Peru
| | - Diana Cruz Condori
- Departamento de Cirugía General y Laparoscópica, Clínica Anglo Americana, Lima, Peru; Laboratorio de Neurogastro Motilidad, Centro de Investigación de Fisiología y Cirugía del Aparato Digestivo, Lima, Peru
| | - Luciano Poggi
- Departamento de Cirugía General y Laparoscópica, Clínica Anglo Americana, Lima, Peru; Laboratorio de Neurogastro Motilidad, Centro de Investigación de Fisiología y Cirugía del Aparato Digestivo, Lima, Peru
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Thaher O, Croner RS, Driouch J, Hukauf M, Stroh C. Reflux disease following primary sleeve gastrectomy: risk factors and possible causes. Updates Surg 2023:10.1007/s13304-023-01477-9. [PMID: 36848002 DOI: 10.1007/s13304-023-01477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION One of the most severe side effects of sleeve gastrectomy (SG) is the development or aggravation of reflux disease. This study investigates the effect of SG on the development of reflux disease and the variables that may impact this development. In addition, trends in revision surgery, weight, and comorbidity are examined among patients with reflux disease and SG and those without reflux disease and SG. This study includes 3379 individuals without reflux disease who had primary SG and were followed for three years. The demographic characteristics, comorbidities, technical features, and complications of SG were analyzed. Data were collected by the German Bariatric Surgery Registry (GBSR). 860 (25.45%) Group A patients had reflux disease following SG (Group B: no reflux after SG; 74.55%). Patients with reflux disease had longer operating times (83.8 min vs. 77.5 min, p < 0.001) and longer postoperative hospital admissions (6 days vs. 5.5 days). In group A, the %EWL was substantially greater than in group B (64.1 vs. 61.1%). 42 patients were converted from SG to RYGB (4.88%), 2 had hiatoplasty, and 5 got Endostim. There is no significant variation in perioperative complications (p value > 0.05). The incidence of complete remission of sleep apnea was higher in group A than in group B (p = 0.013; 50% vs. 44.8%). Other comorbidities were not substantially different. Reflux illness after SG is still poorly understood, despite much research. Technical and preoperative variables may promote its development. However, these assumptions remain theoretical and are not confirmed by scientific data. The majority of patients may be successfully treated using non-invasive methods, although sometimes further surgery is necessary. Despite our results and the literature, this subject is intriguing for further research.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Jamal Driouch
- Department of Surgery, Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße Des Friedens 122, 07548, Gera, Germany
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El Nakeeb A, Aldossary H, Zaid A, El Sorogy M, Elrefai M, Attia M, Sewefy AM, Kayed T, Aldawsari MAS, Al Dossari HM, Mohammed MM. Prevalence, Predictors, and Management of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy: a Multicenter Cohort Study. Obes Surg 2022; 32:3541-3550. [PMID: 36087223 DOI: 10.1007/s11695-022-06264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND One of the most popular bariatric procedures is laparoscopic sleeve gastrectomy (LSG), which can either cause or worsen gastroesophageal reflux disease (GERD). Therefore, the goal of this study was to examine the prevalence, predictors, and management of GERD symptoms after LSG. MATERIALS AND METHODS From January 2017 to January 2022, we looked at patients who had a primary LSG and developed GERD. Before LSG, all patients underwent a barium meal and upper endoscopy. After LSG, barium meal, endoscopy, esophageal manometry, and 24-h pH measurements were performed for selected patients. The diagnosis of GERD is based on the GERD-HRQL questionnaire and upper endoscopy. RESULTS The study included 1537 patients (62.5% women and 37.5% men) with a mean age of 34.4 years. The mean % TWL was 40.7% during a mean follow-up period of 15.9 months. A total of 379 patients (24.7%) experienced postoperative GERD, of whom 328 (21.3%) had postoperative de novo GERD symptoms, 25 (1.6%) had worsened preoperative GERD, and 26 (1.7%) had the same preoperative GERD symptoms. Antral preservation and gastropexy were protective factors against the development of GERD after LSG. LSG was converted to LRYGB in 15.8% of the patients with GERD. The response to medical treatment was observed in 300 (79.2%) patients with GERD. CONCLUSION Post-LSG GERD presented in 379 patients (24.7%). Antral preservation and gastropexy were protective factors for the development of postoperative GERD after LSG. Medical treatment was the main line of treatment for GERD. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05416645.
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Affiliation(s)
- Ayman El Nakeeb
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt. .,Wadi Al Dawasir Armed Forces Hospital, Wadi Al Dawasir, Kingdom of Saudi Arabia.
| | - Hassan Aldossary
- Wadi Al Dawasir Armed Forces Hospital, Wadi Al Dawasir, Kingdom of Saudi Arabia
| | - Ahmed Zaid
- Wadi Al Dawasir Armed Forces Hospital, Wadi Al Dawasir, Kingdom of Saudi Arabia
| | - Mohamed El Sorogy
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamad Elrefai
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed Attia
- Gastrointestinal Surgical Center, and Mansoura University Hospital, Mansoura University, Mansoura, 35516, Egypt
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Balla A, Corallino D, Quaresima S, Palmieri L, Meoli F, Cordova Herencia I, Paganini AM. Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study. Front Surg 2022; 9:906133. [PMID: 35693301 PMCID: PMC9178117 DOI: 10.3389/fsurg.2022.906133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/11/2022] [Indexed: 01/17/2023] Open
Abstract
Aims Indocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate. Methods Thirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2–58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures. Results Fom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case. Conclusions ICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.
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