pH monitoring of gastro-oesophageal reflux before and after laparoscopic sleeve gastrectomy

• Published in: British journal of surgery Vol. 103; no. 4; pp. 399 - 406
• Main Authors: Thereaux, J., Barsamian, C., Bretault, M., Dusaussoy, H., Lamarque, D., Bouillot, J.-L., Czernichow, S., Carette, C.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.03.2016; Oxford University Press; Wiley
• Subjects: Adult; Esophageal pH Monitoring - methods; Female; Follow-Up Studies; Gastrectomy - methods; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - metabolism; Human health and pathology; Humans; Laparoscopy - methods; Life Sciences; Male; Middle Aged; Obesity - complications; Obesity - surgery; Postoperative Period; Preoperative Period; Prospective Studies; Surgery; Time Factors
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.10089

Background Gastro‐oesophageal reflux disease (GORD) is a common obesity‐related co‐morbidity that is assessed objectively by 24‐h pH monitoring. Some concerns have been raised regarding the risk of de novo GORD or exacerbation of pre‐existing GORD after laparoscopic sleeve gastrectomy. Here, 24‐h pH monitoring was used to assess the influence of laparoscopic sleeve gastrectomy on postoperative GORD in obese patients with or without preoperative GORD. Methods From July 2012 to September 2014, all patients scheduled for laparoscopic sleeve gastrectomy were invited to participate in a prospective follow‐up. Patients who underwent preoperative 24‐h pH monitoring were asked to repeat the examination 6 months after operation. GORD was defined as an oesophageal pH < 4 for at least 4·2 per cent of the total time recorded. Results Of 89 patients, 76 had preoperative pH monitoring for GORD evaluation and 50 had postoperative reassessment. Patients without (group 1, 29 patients) or with (group 2, 21 patients) preoperative GORD were similar regarding age, sex ratio and body mass index. In group 1, the median (i.q.r.) total time at pH < 4 was significantly higher after surgery than before: 5·6 (2·5–9·5) versus 1·6 (0·7–2·9) per cent (P < 0·001). Twenty of the 29 patients experienced de novo GORD as determined by 24‐h pH monitoring (P < 0·001). In group 2, total time at pH < 4 after surgery was no different from the preoperative value: 5·9 (3·9–10·7) versus 7·7 (5·2–10·3) per cent (P = 0·296). Conclusion Laparoscopic sleeve gastrectomy was associated with de novo GORD in over two‐thirds of patients, but did not seem to exacerbate existing GORD. High risk of new onset reflux disease