Skip to main content
SpringerLink
Log in

Postoperative outcomes for sleeve gastrectomy patients with positive pH-defined GERD

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Gastroesophageal reflux disease (GERD) is a possible side effect of sleeve gastrectomy (SG). However, procedure selection for patients with GERD and risk factors for morbidity after bypass surgeries is complex. For patients with a preoperative GERD diagnosis, literature related to worsening postoperative symptoms is discordant.

Objective

This study evaluated the effects of SG on patients with pre-operative GERD confirmed through pH testing.

Setting

University Hospital, United States.

Methods

This was a single-center case-series. SG patients with preoperative pH testing were compared based on DeMeester scoring. Preoperative demographics, endoscopy results, need for conversion surgery, and changes in gastrointestinal quality of life (GIQLI) scores were compared. Two-sample independent t-tests assuming unequal variances were used for statistical analysis.

Results

Twenty SG patients had preoperative pH testing. Nine patients were GERD positive; median DeMeester score 26.7 (22.1–31.15). Eleven patients were GERD negative, with a median DeMeester score of 9.0 (4.5–13.1). The two groups had similar median BMI, preoperative endoscopic findings and use of GERD medications. Concurrent hiatal hernia repair was performed in 22% of GERD positive vs. 36% of GERD negative patients, (p = 0.512). Two patients in the GERD positive cohort required conversion to gastric bypass (22%), while none in the GERD negative cohort did. No significant postoperative differences were noted in GIQLI, heartburn, or regurgitation symptoms.

Conclusion

Objective pH testing may allow the differentiation of patients who would be higher risk for need for conversion to gastric bypass. For patients with mild symptoms, but negative pH testing, SG may represent a durable option.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carlin AM, Zeni TM, English WJ et al (2013) The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Ann Surg 257(5):791–797. https://doi.org/10.1097/SLA.0b013e3182879ded

    Article  PubMed  Google Scholar 

  2. Soricelli E, Iossa A, Casella G, Abbatini F, Calì B, Basso N (2013) Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia. Surg Obes Relat Dis 9(3):356–361. https://doi.org/10.1016/j.soard.2012.06.003

    Article  PubMed  Google Scholar 

  3. Tutuian R (2011) Obesity and GERD: pathophysiology and effect of bariatric surgery. Curr Gastroenterol Rep 13(3):205–212. https://doi.org/10.1007/s11894-011-0191-y

    Article  PubMed  Google Scholar 

  4. Mandeville Y, Van Looveren R, Vancoillie PJ et al (2017) 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. Obes Surg 27(7):1797–1803. https://doi.org/10.1007/s11695-017-2567-z

    Article  PubMed  Google Scholar 

  5. Sheppard CE, Sadowski DC, de Gara CJ, Karmali S, Birch DW (2015) Rates of reflux before and after laparoscopic sleeve gastrectomy for severe obesity. Obes Surg 25(5):763–768. https://doi.org/10.1007/s11695-014-1480-y

    Article  PubMed  Google Scholar 

  6. Carter PR, LeBlanc KA, Hausmann MG, Kleinpeter KP, deBarros SN, Jones SM (2011) Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 7(5):569–572. https://doi.org/10.1016/j.soard.2011.01.040

    Article  PubMed  Google Scholar 

  7. Himpens J, Dapri G, Cadière GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16(11):1450–1456. https://doi.org/10.1381/096089206778869933

    Article  PubMed  Google Scholar 

  8. Peterli R, Wölnerhanssen BK, Vetter D et al (2017) Laparoscopic sleeve gastrectomy versus Roux-Y-Gastric bypass for morbid obesity-3-year outcomes of the prospective randomized swiss multicenter bypass or sleeve study (SM-BOSS). Ann Surg 265(3):466–473. https://doi.org/10.1097/SLA.0000000000001929

    Article  PubMed  Google Scholar 

  9. Daes J, Jimenez ME, Said N, Dennis R (2014) Improvement of gastroesophageal reflux symptoms after standardized laparoscopic sleeve gastrectomy. Obes Surg 24(4):536–540. https://doi.org/10.1007/s11695-013-1117-6

    Article  PubMed  Google Scholar 

  10. Pallati PK, Shaligram A, Shostrom VK, Oleynikov D, McBride CL, Goede MR (2014) Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 10(3):502–507. https://doi.org/10.1016/j.soard.2013.07.018

    Article  PubMed  Google Scholar 

  11. DuPree CE, Blair K, Steele SR, Martin MJ (2014) Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg 149(4):328–334. https://doi.org/10.1001/jamasurg.2013.4323

    Article  PubMed  Google Scholar 

  12. Peterli R, Wölnerhanssen BK, Peters T et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS Randomized Clinical Trial. JAMA 319(3):255–265. https://doi.org/10.1001/jama.2017.20897

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ashrafi D, Osland E, Memon MA (2020) Bariatric surgery and gastroesophageal reflux disease. Ann Transl Med 8(Suppl 1):S11. https://doi.org/10.21037/atm.2019.09.15

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gorodner V, Buxhoeveden R, Clemente G, Solé L, Caro L, Grigaites A (2015) Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results. Surg Endosc 29(7):1760–1768. https://doi.org/10.1007/s00464-014-3902-2

    Article  PubMed  Google Scholar 

  15. Del Genio G, Tolone S, Limongelli P et al (2014) Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg 24(1):71–77. https://doi.org/10.1007/s11695-013-1046-4

    Article  PubMed  Google Scholar 

  16. Rebecchi F, Allaix ME, Giaccone C, Ugliono E, Scozzari G, Morino M (2014) Gastroesophageal reflux disease and laparoscopic sleeve gastrectomy: a physiopathologic evaluation. Ann Surg 60(5):909–915. https://doi.org/10.1097/SLA.0000000000000967

    Article  Google Scholar 

  17. Quake SYL, Mohammadi-Zaniani G, Musbahi A, Old O, Courtney M, Small P (2022) Routine use of esophago-gastro-duodenoscopy (EGD) in bariatric surgery-an international survey of our current practice. Obes Surg. https://doi.org/10.1007/s11695-022-06252-0.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Imam A, Asfour G, Imam R et al (2021) Hiatal hernia evaluation before bariatric surgery: should it be routinely done? Obes Surg 31(3):1013–1020. https://doi.org/10.1007/s11695-020-05092-0

    Article  PubMed  Google Scholar 

  19. Ghassemian AJ, MacDonald KG, Cunningham PG et al (1997) The workup for bariatric surgery does not require a routine upper gastrointestinal series. Obes Surg 7(1):16–18. https://doi.org/10.1381/096089297765556169

    Article  CAS  PubMed  Google Scholar 

  20. Georgia D, Stamatina T, Maria N et al (2017) 24-h Multichannel intraluminal impedance pH-metry 1 year after laparocopic sleeve gastrectomy: an objective assessment of gastroesophageal reflux disease. Obes Surg 27(3):749–753. https://doi.org/10.1007/s11695-016-2359-x

    Article  PubMed  Google Scholar 

  21. Balla A, Meoli F, Palmieri L et al (2021) Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review. Langenbecks Arch Surg 406(8):2591–2609. https://doi.org/10.1007/s00423-021-02171-3

    Article  PubMed  PubMed Central  Google Scholar 

  22. Thereaux J, Barsamian C, Bretault M et al (2016) pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy. Br J Surg 103(4):399–406. https://doi.org/10.1002/bjs.10089

    Article  CAS  PubMed  Google Scholar 

  23. Chern TY, Chan DL, Maani J, Ferguson JS, Talbot ML (2021) High-resolution impedance manometry and 24-hour multichannel intraluminal impedance with pH testing before and after sleeve gastrectomy: de novo reflux in a prospective series. Surg Obes Relat Dis 17(2):329–337. https://doi.org/10.1016/j.soard.2020.09.030

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA

    Ila Sethi, Kinga Powers, Amy Rosenbluth & Konstantinos Spaniolas

  2. Division of General Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA

    Aidan Aicher

  3. Department of Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA

    Fareed Cheema

  4. Department of Surgery, Long Island Jewish Medical Center, Queens, NY, USA

    Aurora Pryor

Authors
  1. Ila Sethi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aidan Aicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fareed Cheema
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kinga Powers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amy Rosenbluth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Aurora Pryor
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Konstantinos Spaniolas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ila Sethi.

Ethics declarations

Disclosures

Kinga Powers receives honoraria for speaking for Medtronic and Gore and consulting fees from Gerson Lehrman Group Inc. Aurora Pryor receives honoraria for speaking for Gore, Medtronic, and Stryker and travel reimbursements for consulting for Intuitive. Konstantinos Spaniolas is a Consultant for Intuitive and Medtronic. Ila Sethi, Aidan Aicher, Fareed Cheema, and Amy Rosenbluth have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sethi, I., Aicher, A., Cheema, F. et al. Postoperative outcomes for sleeve gastrectomy patients with positive pH-defined GERD. Surg Endosc 37, 6861–6866 (2023). https://doi.org/10.1007/s00464-023-10149-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-023-10149-z

Keywords

Search

Navigation