title: Intraoperative assessment of the effects of laparoscopic sleeve gastrectomy on the distensibility of the lower esophageal sphincter using impedance planimetry.
abstract: Laparoscopic sleeve gastrectomy (LSG) has emerged as an effective weight-loss procedure for morbid obesity that is also effective for treating comorbidities such as diabetes. However, it has been associated with the development of GERD postoperatively. The pathophysiology of post-LSG GERD is unknown, and current studies have shown conflicting results. The aim of our study is to shed light on this issue by investigating the effect of LSG on the lower esophageal sphincter (LES) function and the relationship of LES function to GERD symptoms.
  
  
  
  A prospective study of patients undergoing LSG from 10/2013 to 8/2014 at a single academic tertiary referral center was carried out. Patients undergoing a concomitant procedure such as hiatal hernia repair or laparoscopic gastric band removal were excluded. Distensibility of the LES was measured after pneumoperitoneum and after LSG. Baseline GERD-HRQL was obtained with follow-up GERD-HRQL and weight at 3 and 6 months. The primary outcomes measured were LES distensibility and GERD-HRQL scores after LSG. Our secondary outcome was a correlation between LES distensibility and GERD-HRQL scores after LSG.
  
  
  
  Fifteen subjects were enrolled (5M/10F). Mean age was 51 years (30-71 years), and mean BMI 45 kg/m2(30-58). We were able to obtain follow-up data for all patients at 3 months. Mean LES distensibility increased from 1.2 before LSG to 2.2 after LSG (p = 0.017). Median GERD-HRQL was 0 before LSG and remained essentially negative at 1 and 0 (3 and 6 months postoperatively, respectively). Three (27 %) of the patients had de novo GERD at 3 months following LSG. One (25 %) patient had remission of GERD. There was no correlation between LES distensibility and GERD symptoms.
  
  
  
  While LSG weakens the LES immediately, it does not predictably affect postoperative GERD symptoms; therefore, distensibility is not the only factor affecting development of postoperative GERD, confirming the multifactorial nature of post-LSG GERD.
authors.affiliation: Department of General Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Reynolds
authors.affiliation: Department of General Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehetner
authors.affiliation: Kaiser Permanente, Sacramento, CA, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Shiraga
authors.affiliation: Department of General Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Lipham
authors.affiliation: Department of General Surgery, Keck Medical Center, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA. namir.katkhouda@med.usc.edu.
authors.forename: Namir
authors.initials: N
authors.lastname: Katkhouda
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D017097:Electric Impedance; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Gastroesophageal reflux disease; Impedance planimetry; Lower esophageal sphincter; Sleeve gastrectomy