title: Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results.
abstract: BACKGROUND
  There is no question that Roux-en-Y gastric bypass (RYGB) is the best treatment option for obesity combined with GERD. However, the influence of laparoscopic sleeve gastrectomy (LSG) on this disease remains controversial. It has been said that LSG could induce de novo GERD or worsen it. The aim of our study was to evaluate the influence of LSG on GERD.
  
  
  METHODS
  Candidates for LSG underwent esophageal manometry (EM) and 24 h pH monitoring before and 1 year after LSG. Symptoms were evaluated using a validated score. Esophageal function test (EFT's) results and symptoms were compared before and after surgery.
  
  
  RESULTS
  Between 4/12 and 9/13, 118 patients underwent LSG. EFT's were performed in 92 (78%) of them preoperatively. From the 19 patients 1 year out of surgery, 14 (73%) completed their EFT's postop. There were 13 women, age 42 ± 12 years, BMI 40 ± 6 kg/m(2). At 14 months, % excess weight loss (EWL) was 74. EM: lower esophageal sphincter (LES) length increased from 2.7 to 3.2 cm (p = NS), and LES pressure decreased from 17.1 to 12.4 mmHg (p ≤ 0.05). Preoperatively, LES was normotensive in 13 (93%) patients; postoperatively, LES was normal in 10 (71%) (p = NS). DeMeester score increased from 12.6 to 28.4 (p ≤ 0.05). Postoperatively, 5 (36%) patients had de novo GERD, in 3 (21%) GERD worsened, 1 (7%) remained with GERD and 5 (36%) remained without reflux. No difference was seen between preop. and postop. symptoms score.
  
  
  CONCLUSIONS
  Our preliminary data showed that after LSG LESP significantly decreased, and the DeMeester score significantly increased. Although LSG results appear appealing in terms of weight loss, patients should be warned that they might need proton pump inhibitors after the operation. Surgeons should probably lower their threshold for indicating RYGB in patients with known preoperative GERD.
authors.affiliation: Programa de Unidades Bariátricas, Buenos Aires, Argentina, vgorodner_72@yahoo.com.ar.
authors.forename: Verónica
authors.initials: V
authors.lastname: Gorodner
authors.forename: Rudolf
authors.initials: R
authors.lastname: Buxhoeveden
authors.forename: Gastón
authors.initials: G
authors.lastname: Clemente
authors.forename: Laura
authors.initials: L
authors.lastname: Solé
authors.forename: Luis
authors.initials: L
authors.lastname: Caro
authors.forename: Alejandro
authors.initials: A
authors.lastname: Grigaites
mesh_terms: D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D016896:Treatment Outcome; D015431:Weight Loss