Patients who are about to undergo bariatric surgery may be better off having a gastric bypass than a sleeve gastrectomy if they also suffer from heartburn, results of a large US analysis suggest.
A review of more than 38,000 bariatric surgery cases found that laparoscopic sleeve gastrectomy (LSG) did not relieve heartburn and may actually have caused gastroesophageal reflux disease (GERD) in some patients. In contrast, Roux-en-Y gastric bypass (GB) was associated with GERD relief. LSG was also associated with reduced weight loss if GERD was present.
“The 2 operations were found to have markedly different effects on GERD,” say the study investigators from the Madigan Army Medical Center in Fort Lewis, Washington, USA.
Matthew Martin and colleagues report in JAMA Surgery that the majority (84.1%) of patients who underwent LSG continued to have GERD symptoms postoperatively, with resolution of symptoms in only 15.9%. Furthermore, 9.0% of patients exhibited a worsening of their GERD symptoms postoperatively and 8.6% of patients who had no preoperative symptoms developed them during a 6-month postoperative period.
GB on the other hand was associated with complete resolution or stabilisation of GERD symptoms in 62.8% and 17.6% of patients, respectively. Symptoms only worsened in 2.2% of cases.
At baseline, 44.5% of 4832 patients who underwent LSG and 50.4% of 33,867 patients who underwent GB during a 3-year period had preoperative GERD. The mean preoperative body mass index in both groups of patients was 47 kg/m2.
Despite higher preoperative rates of hypertension, diabetes, hypercholesterolaemia, and obstructive sleep apnoea in the GB group, the LSG group had more postoperative complications (15.1 vs 10.6%). These included gastrointestinal adverse events in 6.9% and 3.6% of patients, respectively, and a greater chance of revision surgery with LSG than GB (0.6 vs 0.3%).
LSG patients with severe preoperative GERD had a 6% increase in the weight loss failure compared with patients with no preoperative GERD, defined as failure to shed at least half of the excess body weight. By contrast, preoperative GERD had no impact on weight loss in patients who underwent GB.
“Preoperative GERD was associated with worse outcomes and decreased weight loss with LSG,” Martin and team summarise, noting that the presence of GERD might represent a contraindication to LSG.
“We believe that all patients should be evaluated for the presence of GERD and counseled regarding the relative efficacy of LSG vs GB or other bariatric operations before surgery,” the team concludes.
Further study is clearly warranted, however, to clarify the role of preoperative GERD and perhaps identify technical factors that may minimise the risk of developing GERD after LSG.
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