title: Gastroesophageal reflux in laparoscopic sleeve gastrectomy: hiatal findings and their management influence outcome.
abstract: BACKGROUND
  Sleeve gastrectomy (SG) has become a definitive treatment for morbid obesity. There is conflicting evidence on the effects of SG on gastroesophageal reflux disease (GERD).
  
  
  OBJECTIVE
  The objective of this study was to assess whether taking an aggressive approach to managing hiatal weakness in patients undergoing SG results in an alteration in GERD symptoms.
  
  
  METHODS
  Tertiary public hospital and private hospital, Sydney, Australia.
  
  
  METHODS
  Patients undergoing laparoscopic extended (beginning within 2 cm from pylorus) SG were included. If evidence of weakness was present, an anterior hiatal dissection and tight suture repair was performed. If a hiatus hernia was present, formal repair was undertaken. Patients were questioned and scored on preoperative and postoperative reflux symptom frequency and severity, proton pump inhibitor (PPI) usage, current weight, and satisfaction.
  
  
  RESULTS
  A continuous cohort of 262 patients experienced a significant reduction in heartburn frequency (P = .035) and severity (P = .017). Moderate/severe preoperative reflux (Visick score 3 and 4) often improved whether there was a defect requiring repair or not (no repair P = .02, hiatal suture P = .001, hiatus hernia repair P<.001). The severity of symptoms also improved (no repair P = 0.005, hiatal suture P<.001, hiatus hernia repair P< .001).
  
  
  CONCLUSIONS
  Moderate or severe preexisting gastroesophageal reflux improved for most of our obese patients undergoing an extended SG when hiatal defects were routinely repaired. Moderate to severe preoperative reflux also improved in the average obese patient when there was no hiatal defect to repair.
authors: Surgical Outcomes Research Centre, University of Sydney, Royal Prince Alfred, Hospital, Camperdown, Sydney, Australia.
authors: A
authors: A
authors: Lyon
authors: Crosshouse Hospital, Crosshouse, Ayrshire, United Kingdom; Concord Repatriation General Hospital, Concord, Sydney, Australia.
authors: S C
authors: SC
authors: Gibson
authors: Surgical Outcomes Research Centre, University of Sydney, Royal Prince Alfred, Hospital, Camperdown, Sydney, Australia.
authors: K
authors: K
authors: De-loyde
authors: Concord Repatriation General Hospital, Concord, Sydney, Australia; Royal Prince Alfred Hospital Camperdown, Sydney, Australia; Strathfield Private Hospital, Strathfield, New South Wales, Australia. Electronic address: davidmartin72@hotmail.com.
authors: D
authors: D
authors: Martin
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications* / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies
keywords: Bariatric surgery; Gastrectomy; Gastroesophageal reflux; Obesity