title: Moderating the Enthusiasm of Sleeve Gastrectomy: Up to Fifty Percent of Reflux Symptoms After Ten Years in a Consecutive Series of One Hundred Laparoscopic Sleeve Gastrectomies.
abstract: Laparoscopic sleeve gastrectomy (LSG) has become a popular one-stage bariatric procedure with a proven efficacy on weight loss. However, the relationship between LSG and gastroesophageal reflux disease (GERD) remains a subject of debate. The objective is to determine the long-term effect of LSG on weight loss and reflux disease.
  
  
  
  A retrospective analysis of 100 consecutive patients who underwent an LSG between January 2005 and March 2009 was performed. The effect of LSG on weight evolution and the relationship between preoperative and postoperative GERD symptoms and PPI dependency was analyzed.
  
  
  
  A mean follow-up of 8.48 years (range 6.1-10.3) was achieved. We observed a long-term % excess weight loss (%EWL) of 60%. A significant increase in reflux symptoms and use of PPIs was seen. Seventeen percent suffered from reflux disease preoperatively versus 50% at the end of the postoperative follow-up (RR = 2.5882, 95% CI [1.6161-4.1452], p value = 0.0001). The chance of developing de novo reflux after LSG was 47.8% (32/67). Reflux disease was present in 7 of the 26 patients who underwent a secondary Roux-en-Y gastric bypass (RYGB). In four of these seven patients, reflux disease disappeared completely after the secondary RYGB (57.1%).
  
  
  
  A satisfactory long-term effect on weight loss was achieved. However, a significant increase in GERD and PPI dependency after LSG was noted. New onset GERD was seen in more than 40% of the study population. Conversion to RYGB is a good option in patients with refractory reflux disease after LSG.
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium. Yannickmandeville@hotmail.com.
authors.forename: Yannick
authors.identifier: 0000-0001-6191-9115
authors.initials: Y
authors.lastname: Mandeville
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium.
authors.forename: Ruth
authors.initials: R
authors.lastname: Van Looveren
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium.
authors.forename: Peter-Jan
authors.initials: PJ
authors.lastname: Vancoillie
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium.
authors.forename: Xander
authors.initials: X
authors.lastname: Verbeke
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Vandendriessche
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Vuylsteke
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Pattyn
authors.affiliation: AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Smet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: Complication; Gastroesophageal reflux disease; Laparoscopy; Morbid obesity; Proton-pump inhibitor; Secondary gastric bypass; Sleeve gastrectomy