title: Sleeve gastrectomy and development of "de novo" gastroesophageal reflux.
abstract: BACKGROUND
  Sleeve gastrectomy (SG) is currently gaining popularity due to an excellent efficacy combined to minimal anatomic changes. However, some concerns have been raised on increased risk of postoperative gastroesophageal reflux disease (GERD) due to gastric fundus removal, section of the sling muscular fibers of gastroesophageal junction, reduced antral pump function, and gastric volume. We undertook the current study to evaluate by means of high-resolution impedance manometry (HRiM) and combined 24-h pH and multichannel intraluminal impedance (MII-pH) the impact of SG on esophageal physiology.
  
  
  METHODS
  In this study, 25 consecutive patients had HRiM and MII-pH before and after laparoscopic SG. The following parameters were calculated at HRiM: lower esophageal sphincter (LES) pressure and relaxation, peristalsis, number of complete esophageal bolus transit, and mean total bolus transit time. The acid and non-acid GER episodes were assessed by MII-pH with the patient in both upright and recumbent positions.
  
  
  RESULTS
  At a median follow-up of 13 months, HRiM showed an unchanged LES function, increased ineffective peristalsis, and incomplete bolus transit. MII-pH showed an increase of both acid exposure of the esophagus and number of non-acid reflux events in postprandial periods.
  
  
  CONCLUSIONS
  Laparoscopic SG is an effective restrictive procedure that creates delayed esophageal emptying without impairing LES function. A correctly fashioned sleeve does not induce de novo GERD. Retrograde movements and increased acid exposure are probably due to stasis and postprandial regurgitation.
authors.affiliation: Center of Esophagogastric and Obesity Surgery (EGO), XI Division of General and Bariatric Surgery, Second University of Naples, Naples, Italy, gdg@doctor.com.
authors.forename: Gianmattia
authors.initials: G
authors.lastname: Del Genio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
authors.forename: Paolo
authors.initials: P
authors.lastname: Limongelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Brusciano
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Alessandro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rossetti
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.forename: Alberto
authors.initials: A
authors.lastname: del Genio
authors.forename: Federica
authors.initials: F
authors.lastname: del Genio
authors.forename: Ludovico
authors.initials: L
authors.lastname: Docimo
mesh_terms: D000328:Adult; D017097:Electric Impedance; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013270:Stomach / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult