Sleeve gastrectomy and anti-reflux procedures.

Area of Science:

• Bariatric surgery and gastrointestinal health.
• Surgical management of obesity-related complications.

Background:

• Obesity is a major health concern in the USA, leading to premature death.
• Sleeve gastrectomy, a common bariatric procedure, may increase gastroesophageal reflux.
• Reflux following sleeve gastrectomy can sometimes necessitate surgical intervention.

Purpose of the Study:

• To review anti-reflux procedures used before and after sleeve gastrectomy.
• To evaluate surgical options for managing gastroesophageal reflux after sleeve gastrectomy.

Main Methods:

• Extensive literature review of anti-reflux procedures.
• Analysis of techniques supplementing lower esophageal sphincter anatomy.
• Evaluation of re-operation and conversion procedures for reflux management.

Main Results:

• Reviewed procedures include magnetic sphincter augmentation, radiofrequency ablation, hiatal hernia repair, and fundoplication.
• Re-operation for sleeve dilation or conversion to Roux-en-Y gastric bypass (RYGB) are options.
• Concomitant anti-reflux procedures with sleeve gastrectomy were also assessed.

Conclusions:

• Various techniques can mitigate reflux by maintaining or supplementing anti-reflux structures.
• Patients with severe pre-existing reflux should avoid sleeve gastrectomy.
• Conversion to RYGB is the only proven treatment for intractable reflux post-sleeve gastrectomy.