Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy: risk factors and diagnostic aspects

<b>Introduction:</b> Laparoscopic sleeve gastrectomy (LSG) is one of the most popular bariatric surgeries, which contributes to a significant reduction in body weight and improvement of metabolic parameters. At the same time, gastroesophageal reflux disease (GERD) remains one of the key complications after this intervention.<b>Aim:</b> The aim of this study was to determine the main factors contributing to the development of GERD after LSG.<b>Materials and methods:</b> The study included 328 patients (mean age 42.3 9.6 years, mean BMI [body mass index] 41.7 6.1 kg/m) who underwent LSG in 2016-2022. Patients were divided into two groups: the study group (n = 72, 21.95%) - patients with occult GERD, the control group (n = 256, 78.05%) - patients without signs of the study disease. Before the operation, a comprehensive assessment of the patients' condition was performed, including the GERD-HRQL questionnaire and 24-hour pH monitoring (DeMeester index [IDM]). Latent GERD was defined as IDM>14.72 in the absence of symptoms. Postoperative disease was diagnosed on the basis of changes in GERD-HRQL and repeated pH metering 12 months after LSG. The Review Manager program was used for statistical analysis.<b>Results:</b> One year after surgery, 33.23% (n = 109) of patients developed clinically significant GERD. Among those who had latent disease before LSG, 76.38% (n = 55) developed symptoms of the disease. In the control group, the disease appeared in 21.19% (n = 54) of patients, and another 5.08% (n = 13) had a latent form of the disease. Statistical analysis revealed a strong association between the presence of latent disease before surgery and an increased risk of developing clinical disease after LSG (RR: 0.55, OR: 12.10, p<0.001). There was also a tendency to an increased risk of developing this disease in patients over 55 years of age, but this relationship was not statistically significant (p = 0.34), as well as female gender (p = 0.75).<b>Conclusions:</b> LSG is an effective method of treating obesity, but it can contribute to the development of GERD, especially in patients with occult disease. Considering that 76.38% of such patients developed symptoms of the disease after surgery, it is advisable to include preoperative 24-hour pH-metry in the standard examination for the timely detection of occult reflux.