Laparoscopic Revision of Sleeve Gastrectomy with Only Hiatal Hernia Repair for Gastroesophageal Reflux Disease: A Retrospective Study

Abstract

Introduction:

Occurrence of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) has been the subject of numerous studies and is certainly multifactorial in origin. We believe that conversion to Roux-en-Y gastric bypass (RYGB) is the gold standard, but it may not be suitable for all patients.

Methods:

We retrospectively examined 6500 patients who underwent LSG between January 2015 and February 2023 who developed 6 months of GERD unresponsive to medical therapy with descriptive analysis. 240 patients met the inclusion criteria for the study. The GERD-Health-Related Quality of Life (HRQL) questionnaire was used for symptomatic assessment. Perioperative outcomes, progression of GERD symptoms over time, and continued use of proton pump inhibitor therapy postintervention were analyzed. All patients underwent gastrointestinal contrast study (with Gastrografin), esophagogastroduodenoscopy, and HR-esophageal manometry postsurgical revision.

Results:

Body mass index (BMI) was 43.0 ± 5.2 kg/m², while BMI before the revision procedure was 25.7 ± 5.2 kg/m². The mean GERD-health-related quality of life (GERD-HRQL) score before the revision procedure was 14.8 ± 3.5 and decreased to 8.2 ± 3 at 1 month postsurgery. Mean GERD-HRQL scores at 3, 6, and 12 months post-revision were 10.2 ± 3.5, 11.3 ± 4, and 12.1 ± 4, respectively. All patients were taking a daily proton pump inhibitor prior to the revision; only 40% were able to discontinue it after the procedure. 112 patients (46.6%) with a hiatal hernia, normotonic or slightly hypotonic lower esophageal sphincter (LES) were satisfied with the intervention; 72 (30%) had a neutral attitude, and 56 patients with a hypotonic LES (21.4%) reported unchanged symptoms. Of these 56, 20 (35.7%) patients agreed to undergo one-anastomosis gastric bypass (OAGB), and 16 (28.6%) chose RYGB. 14/20 (70%) of those who converted from LSG to OAGB required reconversion to RYGB due to significant bile reflux. After the second revision, an immediate resolution of symptoms was observed.

Conclusions:

Only hiatal hernia repair could be an acceptable treatment option for the occurrence of GERD after LSG in selected cases.