title: Preoperative endoscopy may reduce the need for revisional surgery for gastro-oesophageal reflux disease following laparoscopic sleeve gastrectomy.
abstract: Laparoscopic sleeve gastrectomy is a safe and effective bariatric operation, but postoperative reflux symptoms can sometimes necessitate revisional surgery. Roux-en-Y gastric bypass is the preferred operation in morbidly obese patients with gastro-oesophageal reflux disease. In 2011, we introduced preoperative endoscopy to assess for hiatus hernia or evidence of oesophagitis in conjunction with an assessment of gastro-oesophageal reflux symptoms for all patients undergoing bariatric surgery with a view to avoid sleeve gastrectomy for these patients. A prospectively maintained database was used to identify patients who underwent sleeve gastrectomy before and after we changed the unit policy. The need for revisional surgery in patients with troublesome gastro-oesophageal reflux disease was examined. Prior to 2011, 130 patients underwent sleeve gastrectomy, and 11 (8.5%) of them required conversion to Roux-en-Y gastric bypass for symptomatic reflux disease. Following the policy change, 284 patients underwent sleeve gastrectomy, and to date, only five (1.8%) have required revisional surgery (p = 0.001). Baseline demographics were comparable between the groups, and average follow-up period was 47 and 33 months, respectively, for each group. Preoperative endoscopy and a detailed clinical history regarding gastro-oesophageal reflux symptoms may improve patient selection for sleeve gastrectomy. Avoiding sleeve gastrectomy in patients with reflux disease and/or hiatus hernia may reduce the incidence of revisional surgery.
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: B M
authors.initials: BM
authors.lastname: Madhok
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: W R J
authors.initials: WR
authors.lastname: Carr
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: McCormack
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: M
authors.initials: M
authors.lastname: Boyle
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Jennings
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Schroeder
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Balupuri
authors.affiliation: Bariatric Unit, Department of Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: P K
authors.initials: PK
authors.lastname: Small
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods*; D004724:Endoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies
keywords: Bariatric surgery; endoscopy; reflux; sleeve gastrectomy