title: Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients.
abstract: 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.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile. ibraghet@redclinicauchile.cl
authors.forename: Italo
authors.initials: I
authors.lastname: Braghetto
authors.forename: Enrique
authors.initials: E
authors.lastname: Lanzarini
authors.forename: Owen
authors.initials: O
authors.lastname: Korn
authors.forename: Héctor
authors.initials: H
authors.lastname: Valladares
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Molina
authors.forename: Ana
authors.initials: A
authors.lastname: Henriquez
mesh_terms: 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
chemical_list: D054328:Proton Pump Inhibitors