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GERD post-surgery

LSG does not relieve or resolve GERD

Evidence that procedure may contribute to condition
Patients and surgeons need to be more selective about the procedure

Laparoscopic sleeve gastrectomy does not resolve or relieve gastroesophageal reflux disease (GERD) and in some instances may actually contribute to reflux, according to the study by researchers from the Madigan Army Medical Center, Ft Lewis, WA.

"Bariatric surgery isn't one-operation-fits-all. It really needs to be tailored to the patient," said study author, Dr Matthew Martin. "Somebody who has significant reflux symptoms, or GERD, a sleeve may not be the best option for them, and it's certainly something that needs to be discussed before surgery.”

The research, which sought to report the rates of improvement or worsening of GERD symptoms, development of new-onset GERD, weight loss and complications, was published in the journal JAMA Surgery.

Of the 4,832 patients who underwent LSG and 33 867 who underwent gastric bypass, pre-existing GERD was present in 44.5% of the LSG patients and 50.4% of gastric bypass patients.

The average age of patients in the study was 46 and nearly three-quarters of patients in both groups were women. The average BMI for both groups was 48 before surgery.


Six months post-surgery, 84.1% of LSG patients continued to have GERD symptoms, with only 15.9% demonstrating GERD resolution. In comparison, gastric bypass resolved GERD in most patients (62.8%) within six months postoperatively (p< 0.001), symptoms stabilized in 18 percent of patients, while 2.2 percent saw their symptoms worsen.

Alarmingly, LSG patients who did not demonstrate preoperative GERD, 8.6% developed GERD postoperatively. Moreover, in the LSG group the presence of preoperative GERD was associated with increased postoperative complications (15.1% vs 10.6%), gastrointestinal adverse events (6.9% vs 3.6%), and increased need for revisional surgery (0.6% vs 0.3%) (all p<0.05).

The presence of GERD had no effect on weight loss for the GB cohort but was associated with decreased weight loss in the LSG group.

The researchers concluded that “LSG did not reliably relieve or improve GERD symptoms and induced GERD in some previously asymptomatic patients. Preoperative GERD was associated with worse outcomes and decreased weight loss with LSG and may represent a relative contraindication.”

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