title: Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric procedure, and it can be done as an isolated LSG or in conjunction with biliopancreatic diversion bypass/duodenal switch (laparoscopic duodenal switch; LDS). Gastroesophageal reflux after LSG has been described, but the mechanism is unknown and the treatment in the severest cases has not been discussed. We describe a cohort of patients who have underwent an LSG or LDS, and have suffered from a severe postoperative gastroesophageal motility disorder and/or reflux, report on their treatment, and discuss possible underlying mechanisms.
  
  
  METHODS
  Seven hundred and six patients underwent an LSG by two of the authors (AK, AB). Sixty nine patients underwent laparoscopic sleeve gastrectomy in Hadassah Medical Center, Jerusalem, Israel (January, 2006 and December 2008; 55 isolated LSG, 14 with LDS), and 637 (212 isolated LSG, 425 LDS) in Clinica San Jorge and Alcoy Hospital in Alcoy, Spain, (January 2002 and November 2008).
  
  
  RESULTS
  Of them, eight patients who has suffered from a gastroesophageal dysmotility and reflux disease postoperatively and needed a specific treatment besides regular proton pump inhibitors (PPIs) were identified (1.1%).
  
  
  CONCLUSIONS
  A combination of dilated upper part of the sleeve with a relative narrowing of the midstomach, without complete obstruction, was common to all eight patients who suffered from a severe gastroesophageal dysmotility and reflux. The sleeve volume, the bougie size, and the starting point of the antral resection do not seem to have an effect in this complication. Operative treatment was needed in only one case out of eight; in the rest of the patients, medical modalities were successful. More knowledge is required to understand the underlying mechanisms.
authors: Department of General Surgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel. andreik@hadassah.org.il
authors: Andrei
authors: A
authors: Keidar
authors: Liat
authors: L
authors: Appelbaum
authors: Chaya
authors: C
authors: Schweiger
authors: Ram
authors: R
authors: Elazary
authors: Aniceto
authors: A
authors: Baltasar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D005769:Gastrointestinal Motility; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012086:Reoperation
chemical_list: D054328:Proton Pump Inhibitors