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Original Investigation | Pacific Coast Surgical Association

Laparoscopic Sleeve Gastrectomy in Patients With Preexisting Gastroesophageal Reflux Disease :  A National Analysis

Cecily E. DuPree, DO1; Kelly Blair, MD1; Scott R. Steele, MD1; Matthew J. Martin, MD1
[+] Author Affiliations
1Department of Surgery, Madigan Army Medical Center, Ft Lewis, Washington
JAMA Surg. 2014;149(4):328-334. doi:10.1001/jamasurg.2013.4323.
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Published online

Objectives  To analyze the effect of laparoscopic sleeve gastrectomy (LSG) on patients with gastroesophageal reflux disease (GERD) and to compare the results of LSG vs gastric bypass (GB) among patients with known GERD.

Design, Setting, and Patients  We performed a retrospective review of the Bariatric Outcomes Longitudinal Database from January 1, 2007, through December 31, 2010, including inpatient and all outpatient follow-up data. We compared patients undergoing LSG with a concurrent cohort undergoing GB.

Main Outcomes and Measures  Rates of improvement or worsening of GERD symptoms, development of new-onset GERD, and weight loss and complications.

Results  A total of 4832 patients underwent LSG and 33 867 underwent GB, with preexisting GERD present in 44.5% of the LSG cohort and 50.4% of the GB cohort. Most LSG patients (84.1%) continued to have GERD symptoms postoperatively, with only 15.9% demonstrating GERD resolution. Of LSG patients who did not demonstrate preoperative GERD, 8.6% developed GERD postoperatively. In comparison, GB resolved GERD in most patients (62.8%) within 6 months postoperatively (P < .001). Among the LSG cohort, the presence of preoperative GERD was associated with increased postoperative complications (15.1% vs 10.6%), gastrointestinal adverse events (6.9% vs 3.6%), and increased need for revisional surgery (0.6% vs 0.3%) (all P < .05). The presence of GERD had no effect on weight loss for the GB cohort but was associated with decreased weight loss in the LSG group.

Conclusions and Relevance  Laparoscopic sleeve gastrectomy did not reliably relieve or improve GERD symptoms and induced GERD in some previously asymptomatic patients. Preoperative GERD was associated with worse outcomes and decreased weight loss with LSG and may represent a relative contraindication.

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Figure 1.
Comparison of the Change in Reported Gastroesophageal Reflux Disease (GERD) Symptoms in the Laparoscopic Sleeve Gastrectomy (LSG) and Gastric Bypass (GB) Cohorts With Preoperatively Identified GERD
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Figure 2.
Comparison of the Change in Reported Gastroesophageal Reflux Disease (GERD) Symptoms in the Laparoscopic Sleeve Gastrectomy (LSG) and Gastric Bypass (GB) Cohorts With Preoperatively Identified Severe GERD (GERD Score ≥3)

New-onset GERD occurred in 8.6% of the preoperative GERD-negative patients in the LSG cohort.

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Figure 3.
Resolution of Comorbidities in Laparoscopic Sleeve Gastrectomy (LSG) Patients

GERD indicates gastroesophageal reflux disease.

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