Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients

Gastroesophageal reflux disease (GERD) is highly prevalent in morbidly obese patients and a high body mass index is a risk factor for the development of this co-morbidity. The effect of laparoscopic sleeve gastrectomy (LSG) on GERD is poorly known.

We studied the effect of LSG on GERD in patients with morbid obesity. A retrospective review of 28 consecutive patients undergoing LSG for morbid obesity from September 2008 to September 2010 was performed.

A total of 28 patients, 18 women and 10 men, were identified, with a mean age of 42 years (range 18-60). The mean weight and body mass index was 166 kg and 55.5 kg/m2, respectively. The mean percentage of excess weight loss was 40% (range 17-83), with a mean follow-up time of 32 weeks (range 8-92). All patients had a pre- and postoperative upper gastrointestinal radiographic swallow study as a part of their routine care. Of these patients, 18% were noted to have new-onset GERD on their postoperative upper gastrointestinal swallow test after their LSG procedure. Using the GERD score questionnaire, all patients were interviewed to evaluate their reflux symptoms. We had a 64% response rate, with 22% of patients indicating new-onset GERD symptoms despite receiving daily antireflux therapy. All respondents were extremely happy with their surgery and weight loss to date.

LSG might increase the prevalence of GERD despite satisfactory weight loss. Additional studies evaluating esophageal manometry and ambulatory 24-hours pH-metry are needed to better evaluate the effect of LSG on gastroesophageal reflux symptoms.