Page 80 - World Journal of Laparoscopic Surgery

CLINICAL TECHNIQUE
Concomitant Obesity and GERD: Is Laparoscopic Sleeve

Gastrectomy Still Considered the Best Option? A Clinical

and Endoscopic Evaluation

2
1
Ehab M Oraby , Ola A Harb , Mokhtar A Bahbah 3
Received on: 26 January 2022; Accepted on: 06 September 2022; Published on: 07 December 2022

AbstrAct
Background: Obesity is a real worldwide problem. About one billion people are suffering from obesity all over the world. Two-thirds of the
communities are adults, then the remaining one-third are children and adolescents. Obese patients especially those with central obesity are
showing an incidence of 20–50% for preexisting gastroesophageal reflux disease (GERD).
Objectives: This article is trying to define the relationship between these items in obese patients in our community through clinical and
endoscopic evaluation.
Patients and methods: This prospective study involved 61 patients who were scheduled for bariatric procedures. All patients were invited to
answer a GERD questionnaire and to do upper GI endoscopy twice: once preoperative and second time 1 year postoperatively. Patients were
divided into three groups regarding preexisting GERD and operative procedure.
Results: Group A patients showed significant worsening of GERD scores, endoscopic esophagitis grade, and proton pump inhibitor dependency
(PPI). Group B patients showed significant improvement in GERD scores without improvement in esophagitis grade. Group C patients showed
multifactorial significant improvement.
Conclusion: Laparoscopic sleeve gastrectomy (LSG) operation seems to be truly a refluxogenic procedure, while Roux-En-Y gastric bypass
(RYGB) should be considered as better alternatives to avoid postoperative worsening of GERD and degree of esophagitis. These results need
confirmation by studies with a bigger number of patients.
Keywords: Body mass index, Gastroesophageal reflux disease, Obesity, Sleeve gastrectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1517

IntroductIon 1,3 Department of General Surgery, Benha University, Benha, Egypt
Obesity is a real worldwide problem. About one billion people 2 Department of Pathology, Zagazig University, Cairo, Egypt
are suffering from obesity all over the world. Two-thirds of this Corresponding Author: Ola A Harb, Department of Pathology, Zagazig
community are adults, and the remaining one-third are children University, Cairo, Egypt, Phone: +012234789123, e-mail: olaharb2015@
and adolescents. 1–3 gmail.com
Over the last years, a growing discussion was running around How to cite this article: Oraby EM, Harb OA, Bahbah MA. Concomitant
obesity as a disease. Approaching this disease with a surgical Obesity and GERD: Is Laparoscopic Sleeve Gastrectomy Still Considered
4
intervention was found to have a solid and reliable outcome. the Best Option? A Clinical and Endoscopic Evaluation. World J Lap
Previously, more complicated interventions such as RYGB were Surg 2022;15(3):266–271.
planned for obesity control, while LSG was considered as only a Source of support: Nil
preliminary step before a definitive procedure. Later, LSG was found Conflict of interest: None
to be an effective standalone simple procedure, and no need to add
a further complex step. 5
1,3
Obese patients especially those with central obesity, are novo HH due to migration of gastric tube toward chest cavity.
showing an incidence of 20–50% of preexisting GERD. 1,2,5,6 This Many papers reported variable degrees of de novo GERD and de
high association was attributed to high intra-abdominal pressure novo HH after LSG. Patients after LSG developed de novo GERD
that may increase intragastric pressure, delayed gastric emptying, in 11–70%, de novo HH in 16–73%, and persistence of preexisting
weak lower esophageal sphincter pressure, more frequent lower GERD in about 75–100% of cases. 1,2,6,8–10
1
esophageal relaxations, and associated hiatus hernia (HH). Evaluation of GERD is accomplished through many parameters
The presentation and endoscopic findings of GERD vary from a such as clinical symptoms, pH monitoring, esophageal manometry,
silent condition (10–25%), erosive esophagitis (4–34%), Barrette’s contrast-imaging studies, and upper GI endoscopy. 2
3
esophagus (15%), and even esophageal adenocarcinoma in 0.5%. The relationship between obesity, GERD, and bariatric operations
In the same context, a preexisting HH in morbidly obese patients was studied in many papers, but still, there is a strong debate with
was found to reach 37–50%. 7 wide variations in its results that can be demonstrated in having no
On the other hand, LSG was found to be a Refluxogenic consensus around many items in this topic. This paper is trying to
procedure. This finding was explained by the high pressure in define the relationship between these items in obese patients in our
the gastric tube, crural dissection, disturbed angle of His, and de community through clinical and endoscopic evaluation.

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