Skip to main content
SpringerLink
Log in

Manometric Changes of the Lower Esophageal Sphincter After Sleeve Gastrectomy in Obese Patients

  • Clinical Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Introduction

Laparoscopic sleeve gastrectomy has been accepted as an option for surgical treatment of obesity. After surgery, some patients present reflux symptoms associated with endoscopic esophagitis, therefore PPI’s treatment must be indicated.

Purpose

This study aims to evaluate the manometric characteristic of the lower esophageal sphincter (LES) before and after sleeve gastrectomy

Material and Method

This prospective study includes 20 patients submitted to esophageal manometry in order to determine the resting pressure, and total and abdominal LES length before and after the sleeve gastrectomy. Statistical variations on the LESP were validated according to Student’s “t” test.

Results

Seventeen female and three male patients were included, with a mean age of 37.6 ± 12.6 years. All patients reduced their body weight, from an initial BMI of 38.3 kg/m2 to 28.2 kg/m2 6 months after surgery. No postoperative complications were observed in these patients. Preoperative mean LESP was 14.2 ± 5.8 mmHg. Postoperative manometry decreased in 17/20 (85%), with a mean value of 11.2 ± 5.7 mmHg (p = 0.01). Seven of them presented LESP <12 mmHg and ten patients <6 mmHg after the operation. Furthermore, the abdominal length and total length of the high pressure zone at the esophagogastric junction were affected.

Conclusion

A sleeve gastrectomy produces an important decrease in LES pressure, which can in turn cause the appearance of reflux symptoms and esophagitis after the operation due to a partial resection of the sling fibers during the gastrectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med. 2005;143:199–211.

    PubMed  Google Scholar 

  2. Kendrick ML, Houghton SG. Gastroesophageal reflux disease in obese patients: the role of obesity in management. Dis Esophagus. 2006;19:57–63.

    Article  CAS  PubMed  Google Scholar 

  3. Varela JE, Hinojosa MW, Nguyen NT. Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis. 2009;5:139–43.

    Article  PubMed  Google Scholar 

  4. Friedenberg FK, Xanthopoulos M, Foster GD, et al. The association between gastroesophageal reflux disease and obesity. Am J Gastroenterol. 2008;103:2111–22.

    Article  PubMed  Google Scholar 

  5. Gómez Escudero O, Herrera Hernández MF, Valdovinos Díaz MA. Obesity and gastroesophageal reflux disease. Rev Invest Clin. 2002;54:320–7.

    PubMed  Google Scholar 

  6. Sise A, Friedenberg FK. A comprehensive review of gastroesophageal reflux disease and obesity. Obes Rev. 2008;9:194–203.

    Article  CAS  PubMed  Google Scholar 

  7. Csendes A, Burdiles P, Rojas J, et al. Reflujo gastroesofágico patológico en pacientes con obesidad severa, mórbida e hiper obesidad. Rev Med Chil. 2001;129:1038–43.

    CAS  PubMed  Google Scholar 

  8. Schauer P, Hamad G, Ikramuddin S. Surgical management of gastroesophageal reflux disease in obese patients. Semin Laparosc Surg. 2001;8:256–64.

    Article  CAS  PubMed  Google Scholar 

  9. Di Francesco V, Baggio E, Mastromauro M, et al. Obesity and gastro-esophageal acid reflux: physiopathological mechanisms and role of gastric bariatric surgery. Obes Surg. 2004;14:1095–102.

    Article  PubMed  Google Scholar 

  10. Gutschow CA, Collet P, Prenzel K, et al. Long-term results and gastroesophageal reflux in a series of laparoscopic adjustable gastric banding. J Gastrointest Surg. 2005;9:941–8.

    Article  PubMed  Google Scholar 

  11. Dixon JB, O’Brien PE. Gastroesophageal reflux in obesity: the effect of lap-band placement. Obes Surg. 1999;9:527–31.

    Article  CAS  PubMed  Google Scholar 

  12. Forsell P, Hallerbäck B, Glise H, et al. Complications following Swedish adjustable gastric banding: a long-term follow-up. Obes Surg. 1999;9:11–6.

    Article  CAS  PubMed  Google Scholar 

  13. Csendes A, Burgos AM, Smok G, et al. Effect of gastric bypass on Barrett’s esophagus and intestinal metaplasia of the cardia in patients with morbid obesity. J Gastrointest Surg. 2006;10:259–64.

    Article  PubMed  Google Scholar 

  14. Perry Y, Courcoulas AP, Fernando HC, et al. Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS. 2004;8:19–23.

    PubMed  Google Scholar 

  15. Cobey F, Oelschlager B. Complete regression of Barrett’s esophagus after Roux-en-Y gastric bypass. Obes Surg. 2005;15:710–2.

    Article  PubMed  Google Scholar 

  16. Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.

    Article  PubMed  Google Scholar 

  17. Csendes A, Braghetto I, Burdiles P, et al. Long-term results of classic antireflux surgery in 152 patients with Barrett’s esophagus: clinical, radiological, endoscopic, manometric, and acid reflux test analysis before and late after operation. Surgery. 1998;123:645–57.

    CAS  PubMed  Google Scholar 

  18. Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.

    Article  PubMed  Google Scholar 

  19. Moon Han S, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obes Surg. 2005;15:1469–75.

    Article  PubMed  Google Scholar 

  20. Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy—a "food limiting" operation. Obes Surg. 2008;18:1251–6.

    Article  PubMed  Google Scholar 

  21. Melissas J, Koukouraki S, Askoxylakis J, et al. Sleeve gastrectomy: a restrictive procedure? Obes Surg. 2007;17:57–62.

    Article  PubMed  Google Scholar 

  22. Bernstine H, Tzioni-Yehoshua R, Groshar D, et al. Gastric emptying is not affected by sleeve gastrectomy—scintigraphic evaluation of gastric emptying after sleeve gastrectomy without removal of the gastric antrum. Obes Surg. 2009;19:293–8.

    Article  PubMed  Google Scholar 

  23. Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18:1083–8.

    Article  PubMed  Google Scholar 

  24. Braghetto I, Korn O, Valladares H, et al. Laparoscopic sleeve gastrectomy: surgical technique, indications and clinical results. Obes Surg. 2007;17:1442–50.

    Article  PubMed  Google Scholar 

  25. Arias E, Martínez PR, Ka Ming Li V, et al. Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity. Obes Surg. 2009;5:544–8.

    Article  Google Scholar 

  26. Stein HJ, DeMeester TR, Peters JH, et al. Technique, indications, and clinical use of ambulatory 24-hour gastric pH monitoring in a surgical practice. Surgery. 1994;116:758–67.

    CAS  PubMed  Google Scholar 

  27. Korn O, Csendes A, Burdiles P, et al. Anatomic dilatation of the cardia and competence of the lower esophageal sphincter: a clinical and experimental study. J Gastrointest Surg. 2000;4:398–406.

    Article  CAS  PubMed  Google Scholar 

  28. Klaus A, Weiss H. Is preoperative manometry in restrictive bariatric procedures necessary? Obes Surg. 2008;18:1039–42.

    Article  PubMed  Google Scholar 

  29. Balsinger BM, Murr MM, Mai J, et al. Gastroesophageal reflux after intact vertical banded gastroplasty: correction by conversion to Roux-en-Y gastric Bypass. J Gastrointest Surg. 2000;4:276–81.

    Article  Google Scholar 

  30. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrectomy as a treatment for high risk super obese patients. Obes Surg. 2004;14:492–7.

    Article  PubMed  Google Scholar 

  31. Crookes PF. Management of severe reflux after sleeve gastrectomy 2nd Annual International Consensus Summit on Sleeve Gastrectomy (ICSSG) Miami. March 2009

  32. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5.

    Article  CAS  PubMed  Google Scholar 

  33. Nocca D, Jaussent A, Chauvert MA, et al. Improvement in quality of life after Laparoscopic Sleeve Gastrectomy. 2nd Annual International Consensus Summit on Sleeve Gastrectomy (ICSSG) Miami. March 2009

  34. Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), Ney York City, October 25–27, 2007. Obes Surg. 2008;18:487–96.

    Article  PubMed  Google Scholar 

  35. Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two years results. Surg Endosc. 2007;21:1810–6.

    Article  PubMed  Google Scholar 

  36. Akkary E, Duffy A, Bell R. Deciphering the sleeve: technique, indications, efficiency and safety of sleeve gastrectomy. Obes Surg. 2008;18:1323–9.

    Article  PubMed  Google Scholar 

  37. Fedenko V, Evdosshenko V. Antireflux sleeve gastroplasty: description of a novel technique. Obes Surg. 2007;17:820–4.

    Article  PubMed  Google Scholar 

  38. Santoro S. Technical aspects in sleeve gastrectomy. Obes Surg. 2007;17:1534–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, University of Chile, Santos Dumont 999, Santiago, Chile

    Italo Braghetto, Enrique Lanzarini, Owen Korn, Héctor Valladares, Juan Carlos Molina & Ana Henriquez

Authors
  1. Italo Braghetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enrique Lanzarini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Owen Korn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Héctor Valladares
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Carlos Molina
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ana Henriquez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Italo Braghetto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Braghetto, I., Lanzarini, E., Korn, O. et al. Manometric Changes of the Lower Esophageal Sphincter After Sleeve Gastrectomy in Obese Patients. OBES SURG 20, 357–362 (2010). https://doi.org/10.1007/s11695-009-0040-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-009-0040-3

Keywords

Search

Navigation