title: Sleeve gastrectomy and anti-reflux procedures.
abstract: Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem.
  
  
  
  We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy.
  
  
  
  We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication.
  
  
  
  A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Crawford
authors.affiliation: College of Medicine, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198-5520, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Gibbens
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lomelin
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
authors.forename: Crystal
authors.initials: C
authors.lastname: Krause
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Simorov
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA. doleynik@unmc.edu.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
mesh_terms: D050110:Bariatric Surgery / Q000379:methods; D015904:Biliopancreatic Diversion; D017115:Catheter Ablation; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D018662:Fundoplication / Q000379:methods*; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D059346:Magnets; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation
keywords: Anti-reflux procedures; Gastroesophageal reflux; Obesity; Sleeve gastrectomy