Comparative study about the incidence of gastro esophageal reflux between laparoscopic Sleeve Gastroectomy, laparoscopic Mini Gastric Bypass and laparoscopic gastric bypass roux-en-Y

Abstract

Background: Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. The mini-gastric bypass (MGB) with its low complication rates and possibly better long-term results may be a good alternative to SG, especially in super-obesity. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the procedure of choice for patients with morbid obesity with GERD. Patients and Methods: This is a prospective descriptive study including 68 patients scheduled for LSG MGB and RYGB. Patients were divided according to the type of surgery into LSG (25 patients, group 1), MBG (25 patients, group 2) and RYGB( 18 patients, group 3). Patients were evaluated using the Spanish version of the Carlsson-Dent questionnaire. This questionnaire qualitatively evaluates symptoms associated with GERD and their triggering factors such as diet, posture, and medications used. Evaluation done at 6 months and 1 year postoperatively and only symptomatic GERD patients were evaluated by endoscopic based on clinical questionnaires 6 months postoperatively. Results: The results of this study showed that GERD was more prevalent after SG than MGB and RYGB (12(48%),8(32%) and 3(16.6%) respectively after 6 months post operation. After one year, SG remained more prevalent 32.9% compared with MGB and RYGB which were (8% and 5.5%) respectively. Conclusions: LSG might increase the occurrence of GERD in spite of satisfactory weight loss in compare to MGB and RYGB. In addition, MGB and RYGB may lower the risk of postoperative complication such as gastritis and ulcer in compared with LSG as shown by endoscopic follow-up after 6 month post bariatric surgery in asymptomatic patients.