Laparoscopic Sleeve Gastrectomy and Crural Repair as a Treatment of Morbid Obesity Associated with Gastroesophageal Reflux
Keywords:
Morbid obesity, Reflux esophagitis, Sleeve gastrectomy, Hiatal repair, Weight lossAbstract
Objective: The aim of this study was to evaluate the Laparoscopic Sleeve Gastrectomy (LSG) with simultaneous crural repair in treatment of morbid obesity associated with gastroesophageal reflux disease.
Methods: This prospective observational study was carried out from September 2012 to July 2016 in Al-Azhar University Hospital (Egypt). The study was conducted on 53 patients, 14 males (26.4%) and 39 females (73.6%) with the mean age 36.2 years (range 18-52 years), presenting with morbid obesity and reflux disease either symptomatic patients or asymptomatic (Endoscopic & Manometric), their mean Body Mass Index (BMI) was 50.1 kg/m2 (range 40-62 kg/m2), who underwent LSG and antireflux procedure (crural repair).
Results: Excess weight Loss (EWL); the mean EWL at 6 months postoperatively was 46.3%, at 12 months was 54%, and at 18 months was 61%. Also, we found that, preoperative co-morbidities are resolved by 53% and improved by 23%. Reflux symptoms were absent in 30 patients (56 %), improved in 14 patients (26.4 %), but persistent in 7 patients (13.2 %).
Conclusion: Laparoscopic crural closure, during LSG, represents a valuable option for the treatment of morbid obesity and gastroesophageal reflux, and can result in favorable outcomes in terms of weight loss and gastroesophageal reflux disease (GERD) symptoms control.
References
Hoppin AG. Obesity and the liver: developmental perspectives. Semin Liver Dis. 2004; 24(4): 381-7. doi:
1055/s-2004-860867. PMID: 15605306.
Walsh J. Sleeve gastrectomy as a stand alone bariatric procedure for obesity. California Technology
Assessment Forum. 2010; 13: 1-25.
El-Serag HB, Ergun GA, Pandolfino J, Fitzgerald S, Tran T, Kramer JR. Obesity increases oesophageal
acid exposure. Gut. 2007; 56(6): 749-55. doi: 10.1136/gut.2006.100263. PMID: 17127706, PMCID:
PMC1954847.
Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux
disease and its complications. Ann Intern Med. 2005; 143(3): 199-211. doi: 10.7326/0003-4819-143-3- 200508020-00006. PMID: 16061918.
Morgenthal CB, Lin E, Shane MD, Hunter JG, Smith CD. Who will fail laparoscopic Nissen
fundoplication? Preoperative prediction of long-term outcomes. Surg Endosc. 2007; 21(11): 1978-84. doi:
1007/s00464-007-9490-7. PMID: 17623236.
Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, et al. Meta-analysis:
surgical treatment of obesity. Ann Intern Med. 2005; 142(7): 547-59. doi: 10.7326/0003-4819-142-7- 200504050-00013. PMID: 15809466.
Trelles N, Gagner M. Updated review of sleeve gastrectomy. The Open Gastroenterology J. 2008; 2(1): 41- 9. doi: 10.2174/1874259900802010041.
Strain GW, Gagner M, Inabnet WB, Dakin G, Pomp A. Comparison of effects of gastric bypass and
biliopancreatic diversion with duodenal switch on weight loss and body composition 1-2 years after
surgery. Surg Obes Relat Dis. 2007; 3(1): 31-6. doi: 10.1016/j.soard.2006.09.002. PMID: 17116424.
Rosenthal RJ. International sleeve gastrectomy expert panel consensus statement: best practice guidelines
based on experience of >12,000 cases. Surg Obes Relat Dis. 2011; 1: 12. doi: 10.1016/j.soard.2011.10.019.
Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary
bariatric procedure. Surg Obes Relat Dis. 2009; 5(4): 469-75. doi: 10.1016/j.soard.2009.05.011. PMID:
Uglioni B, Wolnerhanssen B, Peters T, Christoffel-Courtin C, Kern B, Peterli R. Midterm results of
primary vs secondary laparoscopic sleeve gastrectomy (LSG) as an isolated operation. Obes Surg. 2009;
(4): 401-6. doi: 10.1007/s11695-009-9804-z. PMID: 19169763.
Granderath FA, Carlson MA, Champion JK, Szold A, Basso N, Pointner R, et al. Prosthetic closure of the
esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc. 2006;
(3): 367-79. doi: 10.1007/s00464-005-0467-0. PMID: 16424984.
Perry Y, Courcoulas AP, Fernando HC, Buenaventura PO, McCaughan JS, Luketich JD. Laparoscopic
Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS.
; 8(1): 19-23. PMID: 14974657, PMCID: PMC3015506.
Frezza EE, Ikramuddin S, Gourash W, Rakitt T, Kingston A, Luketich J, et al. Symptomatic improvement
in gastroesophageal reflux disease (GERD) following laparoscopic Roux-en-Y gastric bypass. Surg
Endosc. 2002; 16(7): 1027-31. doi: 10.1007/s00464-001-8313-5. PMID: 11984683.
Salvador-Sanchis JL, Martinez-Ramos D, Herfarth A, Rivadulla-Serrano I, Ibañez-Belenguer M, Hoashi
JS. Treatment of morbid obesity and hiatal paraesophageal hernia by laparoscopic Roux-en-Y gastric
bypass. Obes Surg. 2010; 20(6): 801-3. doi: 10.1007/s11695-008-9656-y. PMID: 18773250.
Patterson EJ, Davis DG, Khajanchee Y, Swanström LL. Comparison of objective outcomes following
laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with
heartburn. Surg Endosc. 2003; 17(10): 1561-5. doi: 10.1007/s00464-002-8955-y. PMID: 12874685.
Zainabadi K, Courcoulas AP, Awais O, Raftopoulos I. Laparoscopic revision of Nissen fundoplication to
Roux-en-Y gastric bypass in morbidly obese patients. Surg Endosc. 2008; 22(12): 2737-40. doi:
1007/s00464-008-9848-5. PMID: 18363066.
Greenstein RJ, Nissan A, Jaffin B. Esophageal anatomy and function in laparoscopic gastric restrictive
bariatric surgery: implications for patient selection. Obes Surg. 1998; 8(2): 199-206. doi:
1381/096089298765554818. PMID: 9730394.
Bellanger DE, Greenway FL. Laparoscopic sleeve gastrectomy, 529 cases without a leak: short-term results
and technical considrations. Obes Surg. 2011; 21(2): 146-50. doi: 10.1007/s11695-010-0320-y. PMID:
Jossart GH. Complications of sleeve gastrectomy: bleeding and prevention. Surg Laparosc Endosc Percutan
Tech. 2010; 20(3): 146-7. doi: 10.1097/SLE.0b013e3181e3558b. PMID: 20551810.
Lakdawala MA, Bhasker A, Mulchandani D, Goel S, Jain S. Comparison between the results of
laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in Indian population: a
retrospective 1 year study. Obes Surg. 2010; 20(1): 1-6. doi: 10.1007/s11695-009-9981-9. PMID:
Soliman A, Maged H, Awad A, El-Shiekh O. Laparoscopic Crural Repair With Simultaneous Sleeve
Gastrectomy: A Way in Gastroesophageal Reflux Disease Treatment Associated With Morbid Obesity. J
Minim Invasive Surg Sci. 2012; 1(2): 67-73. doi: 10.17795/minsurgery-5171.
Shah PS, Todkar JS, Shah SS. Effectiveness of laparoscopic sleeve gastrectomy on glycemic control in
obese Indians with type II diabetes mellitus. Surg Obes Relat Dis. 2010; 6(2): 138-41. doi:
1016/j.soard.2009.06.007. PMID: 19733515.
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann
Surg. 2010; 252(2): 319-24. doi: 10.1097/SLA.0b013e3181e90b31. PMID: 20622654.
Sánchez-Santos R, Masdevall C, Baltasar A, Martínez-Blázquez C, García Ruiz de Gordejuela A, Ponsi E.
Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish
Natinal Registry. Obes Surg. 2009; 19(9): 1203-10. doi: 10.1007/s11695-009-9892-9. PMID: 19572113.
Stroh C, Birk D, Flade-Kuthe R, Frenken M, Herbig B, Höhne S, et al. Results of sleeve gastrectomy: data
from a nationwide survey on bariatric surgery in Germany. Obes Surg. 2009; 19(5): 632-40. doi:
1007/s11695-009-9801-2. PMID: 19184256.
Lee CM, Cirangle PT, Jossart GH. Vertical sleeve gastrectomy for morbid obesity in 216 patients: report of
two-years results. Surg Endosc. 2007; 21(10): 1810-6. doi: 10.1007/s00464-007-9276-y. PMID: 17356932.
Hamoui N, Anthone GJ, Kaufman HS, Crookes PF. sleeve gastrectomy in high-risk patients. Obes Surg.
; 16(11): 1445-9. doi: 10.1381/096089206778870157. PMID: 17132409.
Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression and
changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and
sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008; 247(3): 401-7. doi:
1097/SLA.0b013e318156f012. PMID: 18376181.
Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding
and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006; 16(11): 1450-6.
doi: 10.1381/096089206778869933. PMID: 17132410.
Langer FB, Bohdjalian A, Felberbauer FX, Fleischmann E, Reza Hoda MA, Ludvik B, et al. Does gastric
dilatation limit the success of sleeve gastrectomy as a sole operation for morbid obesity? Obes Surg. 2006;
(2): 166-71. doi: 10.1381/096089206775565276. PMID: 16469218.
Peterli R, Wölnerhanssen B, Peters T, Devaux N, Kern B, Christoffel-Courtin C, et al. Improvement in
glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and
laparoscopic sleeve gastrectomy: a prospective randomized trial. Ann Surg. 2009; 250(2): 234-41. doi:
1097/SLA.0b013e3181ae32e3. PMID: 19638921.
Rosenthal R, Li X, Samuel S, Martinez P, Zheng C. Effect of sleeve gastrectomy on patients with diabetes
mellitus. Surg Obes Relat Dis. 2009; 5(4): 429-34. doi: 10.1016/j.soard.2008.11.006. PMID: 19342307.
Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, et al. Effectiveness of laparoscopic
sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in
super-obese high-risk patients. Obes Surg. 2006; 16(9): 1138-44. doi: 10.1381/096089206778392275.
PMID: 16989696.
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