Preoperative endoscopy may reduce the need for revisional surgery for gastro‐oesophageal reflux disease following laparoscopic sleeve gastrectomy. Issue 4 (August 2016)

• Record Type: Journal Article
• Authors: Madhok, B. M.; Carr, W. R. J.; McCormack, C.; Boyle, M.; Jennings, N.; Schroeder, N.; Balupuri, S.; Small, P. K.
• Is Part Of: Clinical obesity. Volume 6:Issue 4(2016)
• Page Start: 268
• Page End: 272
• Publication Date: 2016-08
• Subjects: Bariatric surgery -- endoscopy -- reflux -- sleeve gastrectomy; Obesity -- Periodicals; Obesity -- Treatment -- Periodicals; 616.398005
• DOI: 10.1111/cob.12153
• Languages: English
• ISSNs: 1758-8103

Abstract

Summary: Laparoscopic sleeve gastrectomy is a safe and effective bariatric operation, but postoperative reflux symptoms can sometimes necessitate revisional surgery. Roux‐en‐Y gastric bypass is the preferred operation in morbidly obese patients with gastro‐oesophageal reflux disease. In 2011, we introduced preoperative endoscopy to assess for hiatus hernia or evidence of oesophagitis in conjunction with an assessment of gastro‐oesophageal reflux symptoms for all patients undergoing bariatric surgery with a view to avoid sleeve gastrectomy for these patients. A prospectively maintained database was used to identify patients who underwent sleeve gastrectomy before and after we changed the unit policy. The need for revisional surgery in patients with troublesome gastro‐oesophageal reflux disease was examined. Prior to 2011, 130 patients underwent sleeve gastrectomy, and 11 (8.5%) of them required conversion to Roux‐en‐Y gastric bypass for symptomatic reflux disease. Following the policy change, 284 patients underwent sleeve gastrectomy, and to date, only five (1.8%) have required revisional surgery ( p = 0.001). Baseline demographics were comparable between the groups, and average follow‐up period was 47 and 33 months, respectively, for each group. Preoperative endoscopy and a detailed clinical history regarding gastro‐oesophageal reflux symptoms may improve patient selection for sleeve gastrectomy. Avoiding sleeve gastrectomy in patients with reflux disease and/or hiatus hernia may reduce the incidence of revisional surgery.