Is preoperative manometry necessary for evaluating reflux symptoms in sleeve gastrectomy patients?

The effect of laparoscopic sleeve gastrectomy (LSG) in gastroesophageal reflux disease (GERD) is controversial. However, it has been reported that up to 22% of patients presented with symptomatic GERD after LSG. The aim of our study was to evaluate the necessity of preoperative manometric testing in LSG patients.

We prospectively collected the data on LSG candidate patients who underwent preoperative manometric testing. The normal range for the lower esophageal sphincter (LES) pressure is 10.0-45.0 mmHg. Each patient was interviewed for the GERD score questionnaire (scaled severity and frequency of heartburn, regurgitation, epigastric pain, epigastric fullness, dysphagia and cough) at the time of the manometric study.

Forty-nine patients were studied. The mean preoperative LES pressure was 13.2±7.7 mmHg (range, 1.0-34.4). Eleven patients responded that they had 1 or more moderate to severe GERD symptoms >2-4 times a week, of which 9 had competent LES pressures. Thirteen (26.5%) patients had decreased LES pressures, and only 3 (23.1%) of these reported moderate to severe symptoms of GERD. In 26 LSG patients with postoperative results, the mean preoperative LES pressure was 14.8±8.0 mmHg (range, 3.5-34.4), and the mean GERD score did not show a significant difference at 9 months after LSG. Twenty-two had normal LES pressures, and 16 (72.8%) of these patients reported reflux symptoms preoperatively. Only 2 (12.5%) of these symptomatic patients reported a higher GERD score postoperatively, but the difference was not significant. Of the 4 patients who had low LES pressures, only 1 patient complained of mild GERD symptoms preoperatively. However, this patient and another without preoperative symptoms developed severe GERD symptoms postoperatively.

Manometric study may be necessary in LSG patients to accurately evaluate GERD and the LES pressure.