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Gambardella C, Parisi S, Tolone S, Lucido FS, del Genio G, Brusciano L, Esposito R, de Vito D, Docimo L, Pizza F. Does Antrum Size Matter in Sleeve Gastrectomy? Volume II-A Retrospective Multicentric Study with Long-Term Follow-Up. J Clin Med 2024; 13:3912. [PMID: 38999477 PMCID: PMC11242590 DOI: 10.3390/jcm13133912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) is the most widespread bariatric procedure due to its safety and efficacy. Despite continuous refinement, achieving a globally standardized procedure remains challenging. Moreover, due to its wide adoption, numerous studies have focused on complications associated with the technique, such as gastroesophageal reflux disease (GERD). This study evaluates the impact of antrum size (wide antrectomy versus small antrectomy) in LSG on long-term anthropometric outcomes and complications in patients with morbid obesity. Methods: Body mass index (BMI), percentage of excess weight loss (%EWL) at a 5-year follow-up, GERD Health-Related Quality-of-Life (GERD-HRQL) scores, and obesity-related diseases of patients undergoing LSG with gastric resections starting 2 cm and 6 cm from the pylorus were retrospectively evaluated. Results: Between January 2015 and November 2019, 597 patients who met the criteria for LSG were included in the study. Group A (241 patients) underwent wide antrectomy, while Group B (356 patients) underwent small antrectomy. Weight, BMI, %EWL, and %TWL significantly improved at 6 and 12 months in the wide-antrectomy group. However, these differences diminished by 24 months, with no significant long-term differences in weight loss outcomes between the two groups at 5 years. Conversely, GERD-HRQL scores were significantly better in the small-antrectomy group until 24 months; thereafter, results were comparable between groups over the long term. Conclusions: Therefore, while wide antrectomy may offer superior short-term anthropometric outcomes, both techniques yield similar long-term results regarding weight management and GERD incidence. Larger prospective studies are needed to further address this issue.
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Affiliation(s)
- Claudio Gambardella
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Simona Parisi
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Salvatore Tolone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Francesco Saverio Lucido
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Gianmattia del Genio
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Domenico de Vito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (S.P.); (S.T.); (F.S.L.); (G.d.G.); (L.B.); (R.E.); (D.d.V.); (L.D.)
| | - Francesco Pizza
- Department of Surgery, Aslnapoli2nord, Hospital “A. Rizzoli”, 80076 Naples, Italy;
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Gastroesophageal Reflux Disease Symptoms after Laparoscopic Sleeve Gastrectomy: A Retrospective Study. J Pers Med 2022; 12:jpm12111795. [PMID: 36579535 PMCID: PMC9698432 DOI: 10.3390/jpm12111795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/29/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Background: Laparoscopic sleeve gastrectomy (LSG) is widely performed in bariatric surgery. However, the prevalence and risk factors of gastroesophageal reflux disease (GERD) symptoms after LSG remain unclear to date. This study aimed to identify risk factors of GERD after LSG. (2) Methods: We conducted a retrospective study at Linkou Chang Gung Memorial Hospital and reviewed 296 patients who underwent LSG from 2016 to 2019. A total of 143 patients who underwent preoperative esophagogastroduodenoscopy and completed the 12-month postoperative follow-up were enrolled. Patients’ demographic data, comorbidities, and postoperative weight loss results were recorded for analysis. The GerdQ questionnaire was used to assess GERD after LSG. (3) Results: There were eight surgical complications (5.6%) among the 143 studied patients (median age, 36 years; 56 (39.2%) men; median body weight 105.5 kg; median body mass index [BMI], 38.5 kg/m2). Twenty-three patients (16.1%) developed de novo GERD symptoms. GERD was significantly associated with older age (p = 0.022) and lower BMI (<35 kg/m2, p = 0.028). In multiple logistic regression analysis, age and BMI were significantly associated with GERD. (4) Conclusions: LSG is a safe and effective weight loss surgery. In our study, it led to 16.1% of de novo GERD symptoms, which were significantly related to older age and lower BMI (<35 kg/m2).
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Li JZ, Broderick RC, Huang EY, Serra J, Wu S, Genz M, Sandler BJ, Jacobsen GR, Horgan S. Post Sleeve Reflux: indicators and impact on outcomes. Surg Endosc 2022; 37:3145-3153. [PMID: 35948805 DOI: 10.1007/s00464-022-09454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Post-operative gastroesophageal reflux disease (GERD) remains a significant morbidity following sleeve gastrectomy (SG). We aim to evaluate the incidence and impact within a single center experience. MATERIALS AND METHODS A retrospective review of a prospectively maintained database was performed identifying laparoscopic or robotic SG patients. Primary outcomes included weight loss, rates of post-operative GERD (de-novo or aggravated), and re-intervention. Subgroup analysis was performed between patients with (Group 1) and without (Group 2) post-operative GERD. De-novo GERD and aggravated was defined as persistent GERD complaints or new/increased PPI usage in GERD naive or prior GERD patients, respectively. RESULTS 392 patients were identified between 2014 and 2019. Average demographics: age 42.3 (18-84) years, Charlson Comorbidity Index (CCI) 1.12 (0-10), and body mass index (BMI) 47.7 (28-100). 98% were performed laparoscopically. Average excess weight loss (EWL) was 51.0% and 46.4% at 1 and 2 years post-operatively. Average follow up was 516 (6-2694) days. 69 (17%) patients developed post operative de-novo or aggravated GERD. Group 1 had significantly higher EWL at 9 months (57% vs 47%, p 0.003). 13 (3%) patients required operative re-intervention for GERD and other morbidities: 4 RYGB conversions, 4 diagnostic laparoscopies, 3 HHR, 1 MSA placement. Group 1 had higher rates of post-operative intervention (14% vs 1%, p 0.0001). Subanalysis demonstrated that Group 1 had elevated preoperative DeMeester scores on pH testing (34.8 vs 18.9, p 0.03). De-novo GERD had an elevated post-operative total acid exposure when compared to aggravated GERD (12.7% vs 7.0% p 0.03). No significant differences were found between preoperative endoscopy findings, pre and postoperative total acid exposure, post-operative DeMeester scores, and high-resolution manometry values regarding de-novo/aggravated GERD development. CONCLUSION Preoperative DeMeester scores may serve as risk indicators regarding post-operative GERD. Outcomes such as reintervention remain elevated in post-operative GERD patients.
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Affiliation(s)
- Jonathan Z Li
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Estella Y Huang
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Joaquin Serra
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Samantha Wu
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Michael Genz
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
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Balla A, Corallino D, Quaresima S, Palmieri L, Meoli F, Cordova Herencia I, Paganini AM. Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study. Front Surg 2022; 9:906133. [PMID: 35693301 PMCID: PMC9178117 DOI: 10.3389/fsurg.2022.906133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/11/2022] [Indexed: 01/17/2023] Open
Abstract
Aims Indocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate. Methods Thirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2–58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures. Results Fom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case. Conclusions ICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.
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MEOLI F, CORALLINO D, PALMIERI L, CORDOVA HERENCIA IE, PAGANINI AM. Total gastrectomy after endotherapy failure for management of chronic gastric leakage from sleeve gastrectomy: the end of a nightmare. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Balla A, Palmieri L, Corallino D, Meoli F, Carlotta Sacchi M, Ribichini E, Pronio A, Badiali D, Paganini AM. Does Sleeve Gastrectomy Worsen Gastroesophageal Reflux Disease in Obese Patients? A Prospective Study. Surg Innov 2021; 29:579-589. [PMID: 34865557 DOI: 10.1177/15533506211052745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LGB) on gastroesophageal reflux disease (GERD). METHODS GERD was evaluated by the Modified Italian Gastroesophageal reflux disease-Health-Related Quality of Life (MI-GERD-HRQL) questionnaire, pH-manometry, endoscopy, and Rx-esophagogram, before and 12 months after surgery. Based on these exams, patients without GERD underwent LSG, and patients with GERD underwent LGB. RESULTS Thirteen and six patients underwent LSG and LGB, respectively. After LSG, the only statistically significant difference observed at pH-manometry was the median DeMeester score, from 5.7 to 22.7 (P = .0026). De novo GERD occurred in 6 patients (46.2%), with erosive esophagitis in one. The median MI-GERD-HRQL score improved from 3 to 0. Overall, nine patients underwent LGB, but three were lost to follow-up. Preoperative pH-manometry changed the surgical indication from LSG to LGB in 7 out of 9 patients (77.8%). Six patients who underwent LGB completed the study, and at pH-manometry, statistically significant differences were observed in the percentage of total acid exposure time, with the number of reflux episodes lasting >5 minutes and DeMeester score (P = .009). The median MI-GERD-HRQL score improved from 6.5 to 0. Statistically significant differences were not observed at endoscopy and Rx-esophagogram findings in both groups. CONCLUSIONS LSG has a negative impact on GERD, even in patients without preoperative GERD. LGB confirmed to be the intervention of choice in patients with GERD. Preoperative pH-manometry may identify patients with silent GERD, to candidate them to LGB rather than LSG. pH-manometry should be used more liberally to establish the correct surgical indication on objective grounds.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Livia Palmieri
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Diletta Corallino
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Francesca Meoli
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Maria Carlotta Sacchi
- Department of Translational and Precision Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Emanuela Ribichini
- Department of Translational and Precision Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Annamaria Pronio
- Digestive Endoscopy Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Danilo Badiali
- Department of Translational and Precision Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
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Leslie D, Wise E, Sheka A, Abdelwahab H, Irey R, Benner A, Ikramuddin S. Gastroesophageal Reflux Disease Outcomes After Vertical Sleeve Gastrectomy and Gastric Bypass. Ann Surg 2021; 274:646-653. [PMID: 34506320 DOI: 10.1097/sla.0000000000005061] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this study is to assess whether vertical sleeve gastrectomy (VSG) increases the incidence of gastroesophageal reflux disease (GERD), esophagitis and Barrett esophagus (BE) relative to patients undergoing Roux-en-Y gastric bypass (RYGB) in patients with and without preoperative GERD. SUMMARY OF BACKGROUND DATA Concerns for potentiation of GERD, supported by multiple high-quality retrospective studies, have hindered greater adoption of the VSG. METHODS From the OptumLabs Data Warehouse, VSG and RYGB patients with ≥2 years enrollment were identified and matched by follow-up time. GERD [reflux esophagitis, prescription for acid reducing medication (Rx) and/or diagnosis of BE], upper endoscopy (UE), and re-admissions were evaluated beyond 90 days. RESULTS A total of 8362 patients undergoing VSG were matched 1:1 to patients undergoing RYGB, on the basis of post-operative follow-up interval. Age, sex, and follow-up time were similar between the 2 groups (P > 0.05). Among all patients, postoperative GERD was more frequently observed in VSG patients relative to RYGB patients (60.2% vs 55.6%, respectively; P < 0.001), whereas BE was more prevalent in RYGB patients (0.7% vs 1.1%; P = 0.007). Postoperatively, de novo esophageal reflux symptomatology was more common in VSG patients (39.3% vs 35.3%; P < 0.001), although there was no difference in development of the histologic diagnoses reflux esophagitis and BE. Furthermore, postoperative re-admission was higher in the RYGB cohort (38.9% vs 28.9%; P < 0.001). CONCLUSIONS Compared to RYGB, VSG may not have inferior long-term GERD outcomes, while also leading to fewer re-hospitalizations. These data challenge the prevailing opinion that patients with GERD should undergo RYGB instead of VSG.
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Affiliation(s)
- Daniel Leslie
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Eric Wise
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Adam Sheka
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | | | - Ryan Irey
- Institute for Healthcare Informatics, University of Minnesota, Minneapolis, MN
| | - Ashley Benner
- Clinical & Translational Science Institute, University of Minnesota, Minneapolis, MN
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Balla A, Meoli F, Palmieri L, Corallino D, Sacchi MC, Ribichini E, Coletta D, Pronio A, Badiali D, Paganini AM. Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review. Langenbecks Arch Surg 2021; 406:2591-2609. [PMID: 33855600 PMCID: PMC8803809 DOI: 10.1007/s00423-021-02171-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/05/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE Aim of this systematic review is to assess the changes in esophageal motility and acid exposure of the esophagus through esophageal manometry and 24-hours pH-monitoring before and after laparoscopic sleeve gastrectomy (LSG). METHODS Articles in which all patients included underwent manometry and/or 24-hours pH-metry or both, before and after LSG, were included. The search was carried out in the PubMed, Embase, Cochrane, and Web of Science databases, revealing overall 13,769 articles. Of these, 9702 were eliminated because they have been found more than once between the searches. Of the remaining 4067 articles, further 4030 were excluded after screening the title and abstract because they did not meet the inclusion criteria. Thirty-seven articles were fully analyzed, and of these, 21 further articles were excluded, finally including 16 articles. RESULTS Fourteen and twelve studies reported manometric and pH-metric data from 402 and 547 patients, respectively. At manometry, a decrease of the lower esophageal sphincter resting pressure after surgery was observed in six articles. At 24-hours pH-metry, a worsening of the DeMeester score and/or of the acid exposure time was observed in nine articles and the de novo gastroesophageal reflux disease (GERD) rate that ranged between 17.8 and 69%. A meta-analysis was not performed due to the heterogeneity of data. CONCLUSIONS After LSG a worsening of GERD evaluated by instrumental exams was observed such as high prevalence of de novo GERD. However, to understand the clinical impact of LSG and the burden of GERD over time further long-term studies are necessary.
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Affiliation(s)
- Andrea Balla
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Francesca Meoli
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Livia Palmieri
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Diletta Corallino
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Maria Carlotta Sacchi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Emanuela Ribichini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Diego Coletta
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Annamaria Pronio
- Digestive Endoscopy Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Danilo Badiali
- Department of Translational and Precision Medicine, Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - Alessandro M Paganini
- Bariatric Surgery Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
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Predictive Factors of Gastroesophageal Reflux Disease Symptoms Following Open Sleeve Gastrectomy in Brazil Using Clinical Questionnaire. Obes Surg 2021; 31:3090-3096. [PMID: 33725297 DOI: 10.1007/s11695-021-05333-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate predictors of symptoms of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) based on a clinical questionnaire. MATERIALS AND METHODS This is a cross-sectional study. We included all patients who underwent open SG between May 2013 and March 2017 in a single institution. Patients who could not be contacted or who did not want to participate were excluded. Clinical, demographic, and pre- and postoperative data were collected on medical records. Patients were contacted via telephone and inquired about GERD symptoms postoperatively. Symptoms were quantified using the GERD Questionnaire (GERDq). Patients were divided into three study groups according to GERDq score: asymptomatic (GERDq = 0), mildly symptomatic (GERDq ≤ 8), and severely symptomatic (GERDq > 8). Univariate analysis was performed using ANOVA, Kruskal-Wallis, Dunn, and chi-square tests. A logistic regression model was built for adjusted analysis of the data. RESULTS One hundred eighty-nine patients were included. Mean age was 39.7 ± 10.71 years and 45.5% were female. Postoperative median follow-up period was 4.55 years (interquartile range 5.34-3.76). Mean GERDq score was 7.62 ± 10.17. Sixty-four patients were asymptomatic, 63 were mildly symptomatic, and 62 were severely symptomatic. The group of severely symptomatic patients showed a statistically lower preoperative weight when compared to the other groups (p = 0.049), but this association was not observed when analyzing preoperative BMI (p = 0.427). The other variables were not associated with postoperative GERD symptoms, both in univariate and adjusted analysis. CONCLUSION No variables were statistically and clinically predictive of GERD occurrence or severity after SG. The pathophysiology of GERD is complex and further studies are needed to elucidate this condition.
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Pizza F, D'Antonio D, Lucido FS, Tolone S, Dell'Isola C, Gambardella C. Postoperative Clinical-Endoscopic Follow-up for GERD and Gastritis After One Anastomosis Gastric Bypass for Morbid Obesity: How, When, and Why. Obes Surg 2020; 30:4391-4400. [PMID: 32621053 DOI: 10.1007/s11695-020-04805-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The one anastomosis gastric bypass (OAGB) is a widely diffused surgical procedure for morbid obesity. Several studies considered OAGB at risk for biliary reflux and anastomotic ulcers. The aim of the study was to evaluate gastro-esophageal reflux disease (GERD) and esophagitis/gastritis rate after OAGB diagnosed by upper endoscopy (UE), comparing the results with GERD-Health-Related Quality of Life (HRQL) score. METHODS From July 2014 to February 2019, patients underwent OAGB with at least 12-month follow-up were retrospectively evaluated. Clinical evaluation was associated with GERD-HRQL scoring. UE with a mucosal biopsy was also performed. A comparison among clinical scores and endoscopic findings was performed. RESULTS Two hundred forty-one patients were analyzed in the study. Anthropometric features (BMI, %Excess weight loss, %Total weight loss) were significantly improved. Only 30% of patients with GERD-HQRL>30 showed esophagitis at UE: 11/181 (6.1%) showed grade A erosive esophagitis, 2/181 (1.1%) grade B esophagitis, whereas no patient resulted in grade C/D. Fifty-two patients (28.7%) showed endoscopic remnant gastritis of at least grade 1, with histological gastritis of at least mild grade in 70/181 patients (38.7%). CONCLUSION OAGB is a feasible and effective procedure in terms of weight reduction and comorbidities control, but controversies remain about the long-term onset of GERD and bile reflux. The incidence of esophagitis was increased after OAGB. However, the severity and incidence were lower compared to sleeve gastrectomy. Conversely, the incidence of gastritis, ileo-gastric anastomotic inflammation, and HP positivity were not negligible, suggesting the potential benefits of endoscopic surveillance after OAGB.
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Affiliation(s)
- Francesco Pizza
- Division of General and Emergency Surgery, Asl Napoli 2 nord, Frattamaggiore, Naples, Italy.
| | - Dario D'Antonio
- Division of General and Emergency Surgery, Asl Napoli 2 nord, Frattamaggiore, Naples, Italy
| | - Francesco Saverio Lucido
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Tolone
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Chiara Dell'Isola
- AORN "dei Colli" Monaldi-Cotugno_CTO Department of Infectious Diseases, Naples, Italy
| | - Claudio Gambardella
- Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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