Gastroesophageal reflux disease complicating laparoscopic sleeve gastrectomy: current knowledge and surgical therapies |
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| Affiliation: | 1. Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China;2. Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China;3. Department of General Surgery, Yaan People’s Hospital, Yaan, China;1. Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH;2. Kaiser Permanente Anaheim Medical Center, Anaheim, CA;3. University of Alberta, Edmonton, AB, Canada;1. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy;2. Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy;1. Upper Gastrointestinal Surgery, St George Private Hospital, Sydney, Australia;2. Faculty of Medicine, Department of Surgery, University of New South Wales, Sydney, Australia;3. Faculty of Medicine, Western Sydney University, Sydney, Australia;1. Surgical Outcomes Research Centre, University of Sydney, Royal Prince Alfred, Hospital, Camperdown, Sydney, Australia;2. Crosshouse Hospital, Crosshouse, Ayrshire, United Kingdom;3. Concord Repatriation General Hospital, Concord, Sydney, Australia;4. Royal Prince Alfred Hospital Camperdown, Sydney, Australia;5. Strathfield Private Hospital, Strathfield, New South Wales, Australia |
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| Abstract: | BackgroundLaparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedure worldwide. However, the incidence of gastroesophageal reflux disease (GERD) after LSG is high.ObjectivesThe aim of this systematic review was to identify the optimal surgical strategy for treating GERD after LSG.SettingWest China Hospital, Sichuan University, Chengdu, China.MethodsA systematic literature search was performed to identify studies on surgical treatments for GERD after LSG. The effectiveness and safety profile of surgical management on GERD after LSG were analyzed.ResultsA total of 40 articles enrolling 2049 patients were included in this review. Surgical strategies to prevent GERD after LSG were mainly of 2 types: concomitant LSG + antireflux procedures (hiatal hernia repair or fundoplication) and secondary procedures (conversion to Roux-en-Y gastric bypass [RYGB] or repeat sleeve gastrectomy). The short-term remission or improvement rate of GERD was 34.6%–100% after concomitant LSG + antireflux procedures. The postoperative complication rate was the same (3.0%) for both LSG + antireflux procedures and LSG alone. The remission or improvement rate of GERD was 57.1%–100% after conversion to RYGB and 100% after repeat sleeve gastrectomy.ConclusionsThe effectiveness and safety profile of concomitant LSG + antireflux procedures is uncertain. However, secondary operations after LSG, such as conversion to RYGB, appear to provide good results. The data overall are heterogeneous, with imprecise methods of documenting and defining GERD complicating LSG. More cohort studies or RCT studies of high quality with long-term follow-up are needed in the future. |
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| Keywords: | Sleeve gastrectomy Revisional surgery Bariatric surgery Gastroesophageal reflux |
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