title: Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity.
abstract: BACKGROUND
  A current management dilemma in laparoscopic sleeve gastrectomy (LSG) patients is the development of significant gastroesophageal reflux symptoms after surgery. Treatment is typically directed towards reducing acid reflux despite the surgical removal of parietal cell mass. In contrast, laparoscopic Roux-en-Y gastric bypass (LRYGB) has been known to reduce or resolve preoperative reflux symptoms. The objective of this study was to determine the incidence of preoperative and postoperative reflux of LSG and LRYGB patients, and review reflux treatment type and response.
  
  
  METHODS
  A retrospective chart review was performed for patients undergoing either LSG or LRYGB between January 2010 and December 2012 as part of the Weight Wise program, Royal Alexandra Hospital, Edmonton, Canada.
  
  
  RESULTS
  A total of 387 cases were included in our review. We observed a significant reduction in BMI postoperatively for both LSG and LRYGB groups (p < 0.001). Between surgical groups, preoperative proton-pump inhibitor (PPI) use was not significantly different; however, at 1 month (p < 0.05) to 1-2 years (p < 0.001), there was significantly increased PPI use in patients after LSG in comparison to LRYGB. Of the LSG patients that continued their PPI treatment after surgery, 58% increased, 42% continued the same, and 0% decreased their dose 1 year after surgery.
  
  
  CONCLUSIONS
  Reflux symptoms are significantly increased after LSG in comparison to LRYGB patients. In addition, LSG patients more frequently require initiation of reflux treatment after surgery than that of LRYGB patients. Patients reported postoperative reflux symptom relief with acid-suppressant therapies.
authors.affiliation: Centre for the Advancement of Minimally Invasive Surgery, Rm 502 Community Services Centre, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Sheppard
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Sadowski
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: de Gara
authors.forename: Shahzeer
authors.initials: S
authors.lastname: Karmali
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Birch
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D057234:Preoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome