Is preoperative manometry in restrictive bariatric procedures necessary?
BACKGROUND
Restrictive bariatric procedures are frequently considered for patients with morbid obesity, because the weight loss and reduction of comorbidities are good. An impact on gastroesophageal reflux disease (GERD), which is common in this population, may be anticipated. Converse results of GERD symptoms are reported for patients after adjustable gastric banding (AGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGBP).


METHODS
A literature search was performed and, with our personal experience, are summarized.


RESULTS
Esophageal manometry is a practical tool to identify functional disorders of the esophageal body and the lower esophageal sphincter (LES). For patients with weak esophageal body motility, AGB should not be considered as a therapeutic option because esophageal dilation, esophageal stasis, and consequent esophagitis often occur during long-term follow-up, and band deflation is inevitable. Stable body weight can therefore not be achieved in these patients. Low resting pressure of the LES may be a contraindication for SG, because taking away the angle of His further impairs the antireflux mechanism at the cardia. So far, RYGBP is an option for all morbidly obese patients regardless of the results of esophageal manometry.


CONCLUSIONS
Preoperative esophageal manometry is advised for restrictive procedures such as AGB and SG.
Klaus
Alexander
A
Department of General and Transplant Surgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Austria. alexander.klaus@i-med.ac.at
Weiss
Helmut
H
D050110:Bariatric Surgery / Q000009:adverse effects; D004947:Esophagus / Q000503:physiopathology*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008365:Manometry; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011300:Preoperative Care; D012307:Risk Factors