Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients.
BACKGROUND
Laparoscopic sleeve gastrectomy has been accepted as an option for surgical treatment of obesity. After surgery, some patients present reflux symptoms associated with endoscopic esophagitis, therefore PPI's treatment must be indicated.


OBJECTIVE
This study aims to evaluate the manometric characteristic of the lower esophageal sphincter (LES) before and after sleeve gastrectomy


METHODS
This prospective study includes 20 patients submitted to esophageal manometry in order to determine the resting pressure, and total and abdominal LES length before and after the sleeve gastrectomy. Statistical variations on the LESP were validated according to Student's "t" test.


RESULTS
Seventeen female and three male patients were included, with a mean age of 37.6 +/- 12.6 years. All patients reduced their body weight, from an initial BMI of 38.3 kg/m(2) to 28.2 kg/m(2) 6 months after surgery. No postoperative complications were observed in these patients. Preoperative mean LESP was 14.2 +/- 5.8 mmHg. Postoperative manometry decreased in 17/20 (85%), with a mean value of 11.2 +/- 5.7 mmHg (p = 0.01). Seven of them presented LESP <12 mmHg and ten patients <6 mmHg after the operation. Furthermore, the abdominal length and total length of the high pressure zone at the esophagogastric junction were affected.


CONCLUSIONS
A sleeve gastrectomy produces an important decrease in LES pressure, which can in turn cause the appearance of reflux symptoms and esophagitis after the operation due to a partial resection of the sling fibers during the gastrectomy.
Braghetto
Italo
I
Department of Surgery, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile. ibraghet@redclinicauchile.cl
Lanzarini
Enrique
E
Korn
Owen
O
Valladares
Héctor
H
Molina
Juan Carlos
JC
Henriquez
Ana
A
D000328:Adult; D015992:Body Mass Index; D049630:Esophageal Sphincter, Lower / Q000502:physiology / Q000503:physiopathology*; D050782:Esophageal pH Monitoring; D004941:Esophagitis / Q000188:drug therapy / Q000209:etiology; D004943:Esophagogastric Junction / Q000033:anatomy & histology* / Q000502:physiology; D004945:Esophagoscopy; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors