title: Functional importance of laparoscopic sleeve gastrectomy for the lower esophageal sphincter in patients with morbid obesity.
abstract: BACKGROUND
  Obesity is characterized by excess body fat measured in body mass index (BMI), which is the weight in kilograms (kg) divided by the height in square meters [m(2)]. In the Northern Hemisphere, the prevalence of overweight has increased by up to 34%. This situation is associated with high incidence of comorbidities such as gastroesophageal reflux disease. Bariatric surgery is the only effective treatment for severe obesity, resulting in amelioration of obesity comorbidities. Data on LES competence following sleeve gastrectomy (SG), one of the several bariatric procedures, are conflicting.
  
  
  METHODS
  In a prospective study, we enrolled 37 patients and divided them into two subgroups in order to evaluate lower esophageal sphincter pressure (LESP) and esophageal motility before and after laparoscopic sleeve gastrectomy (LSG) by means of stationary esophageal manometry. A study collective also underwent a gastroscopy. Participants (20) were healthy controls who volunteered.
  
  
  RESULTS
  Preoperative median BMI in group I (control) differed statistically significantly (p < 0.0001) as compared to groups II and III (22 vs. 50.5 or 47.5 kg/m², respectively). After LSG, the BMI of groups II and III decreased to 39.5 and 45 kg/m², respectively. Postoperatively, LESP increased significantly, namely, from preoperative 8.4 to 21.2 mmHg in group II and from 11 to 24 mmHg (p < 0.0001) in group III. Tubular esophageal motility profits from LSG. As expected, the gastroscopy findings ranged from cardiac insufficiency, esophagitis and hiatal hernia to gastric ulcer.
  
  
  CONCLUSIONS
  LSG significantly increased lower esophageal pressure independent of weight loss after LSG and may protect obese patients from gastroesophageal reflux.
authors: Department of General, Visceral and Transplant Surgery, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
authors: Wiebke V
authors: WV
authors: Petersen
authors: Tobias
authors: T
authors: Meile
authors: Markus A
authors: MA
authors: Küper
authors: Marty
authors: M
authors: Zdichavsky
authors: Alfred
authors: A
authors: Königsrainer
authors: Joachim H
authors: JH
authors: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology* / Q000601:surgery; D050782:Esophageal pH Monitoring; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D005858:Germany / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome