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Erschienen in: Obesity Surgery 5/2020

07.03.2020 | Original Contributions

Sleeve Gastrectomy and Anterior Fundoplication (D-SLEEVE) Prevents Gastroesophageal Reflux in Symptomatic GERD

verfasst von: Gianmattia del Genio, Salvatore Tolone, Claudio Gambardella, Luigi Brusciano, Mariachiara Lanza Volpe, Giorgia Gualtieri, Federica del Genio, Ludovico Docimo

Erschienen in: Obesity Surgery | Ausgabe 5/2020

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Abstract

Background

A worrying increase of gastroesophageal reflux disease (GERD) and Barrett esophagus has been reported after sleeve gastrectomy (SG). Recent reports on combined fundoplication and SG seem to accomplish initial favorable results. However, no study included manometry or pH monitoring to evaluate the impact of fundoplication in SG on esophageal physiology.

Method

In this study, 32 consecutive bariatric patients with GERD and/or esophagitis had high-resolution impedance manometry (HRiM) and combined 24-h pH and multichannel intraluminal impedance (MII-pH) before and after laparoscopic sleeve gastrectomy associated to anterior fundoplication (D-SLEEVE). The following parameters were calculated at HRiM: lower esophageal sphincter pressure and relaxation, peristalsis, and mean total bolus transit time. The acid and non-acid GER episodes were assessed by MII-pH, symptom index association (SI), and symptom-association probability (SAP) were also analyzed.

Results

At a median follow-up of 14 months, HRiM showed an increased LES function, and MII-pH showed an excellent control of both acid exposure of the esophagus and number of reflux events. Bariatric outcomes (BMI and EWL%) were also comparable to regular SG (p = NS).

Conclusion

D-SLEEVE is an effective restrictive procedure, which recreates a functional LES pressure able to control and/or prevent mild GERD at 1-year follow-up.
Literatur
2.
Zurück zum Zitat Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.CrossRef Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.CrossRef
3.
Zurück zum Zitat Helvetius M. Observation sur le estomac de la Homme. Historie de l'Accademie Royale des Sciences. 1719; p. 337–45. Helvetius M. Observation sur le estomac de la Homme. Historie de l'Accademie Royale des Sciences. 1719; p. 337–45.
4.
Zurück zum Zitat Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(6):751–6.CrossRef Soricelli E, Casella G, Baglio G, et al. Lack of correlation between gastroesophageal reflux disease symptoms and esophageal lesions after sleeve gastrectomy. Surg Obes Relat Dis. 2018;14(6):751–6.CrossRef
5.
6.
Zurück zum Zitat Sebastianelli L, Benois M, Vanbiervliet G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study. Obes Surg. 2019;29:1462–9.CrossRef Sebastianelli L, Benois M, Vanbiervliet G, et al. Systematic endoscopy 5 years after sleeve gastrectomy results in a high rate of Barrett’s esophagus: results of a multicenter study. Obes Surg. 2019;29:1462–9.CrossRef
7.
Zurück zum Zitat Doulami G, Triantafyllou S, Natoudi M, et al. 24-h multichannel intraluminal impedance pHmetry 1 year after laparoscopic sleeve gastrectomy: an objective assessment of gastroesophageal reflux disease. Obes Surg. 2017;27:749–53.CrossRef Doulami G, Triantafyllou S, Natoudi M, et al. 24-h multichannel intraluminal impedance pHmetry 1 year after laparoscopic sleeve gastrectomy: an objective assessment of gastroesophageal reflux disease. Obes Surg. 2017;27:749–53.CrossRef
8.
Zurück zum Zitat Sharma A, Aggarwal S, Ahuja V, et al. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014;10:600–5.CrossRef Sharma A, Aggarwal S, Ahuja V, et al. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014;10:600–5.CrossRef
11.
Zurück zum Zitat Foschi D, De Luca M, Sarro G, Bernante P, Zappa MA, Moroni R, Navarra G, Foletto M, Ceriani V, Piazza L, Di Lorenzo N. Linee Guida di Chirurgia dell’Obesità. Ed. Società Italiana di Chirurgia dell’Obesità e delle Malattie Metaboliche (S.I.C.OB.), 2016. Foschi D, De Luca M, Sarro G, Bernante P, Zappa MA, Moroni R, Navarra G, Foletto M, Ceriani V, Piazza L, Di Lorenzo N. Linee Guida di Chirurgia dell’Obesità. Ed. Società Italiana di Chirurgia dell’Obesità e delle Malattie Metaboliche (S.I.C.OB.), 2016.
12.
Zurück zum Zitat Del Genio G, Tolone S, Del Genio F, et al. Impact of total fundoplication on esophageal transit: analysis by combined multichannel intraluminal impedance and manometry. J Clin Gastroenterol. 2012;46(1):e1–5.CrossRef Del Genio G, Tolone S, Del Genio F, et al. Impact of total fundoplication on esophageal transit: analysis by combined multichannel intraluminal impedance and manometry. J Clin Gastroenterol. 2012;46(1):e1–5.CrossRef
13.
Zurück zum Zitat Pizza F, Rossetti G, Limongelli P, et al. Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol. 2007;13(5):740.CrossRef Pizza F, Rossetti G, Limongelli P, et al. Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol. 2007;13(5):740.CrossRef
14.
Zurück zum Zitat Shikora SA, Kim JJ, Tarnoff ME, et al. Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg. 2005;140(4):362–7.CrossRef Shikora SA, Kim JJ, Tarnoff ME, et al. Laparoscopic Roux-en-Y gastric bypass: results and learning curve of a high-volume academic program. Arch Surg. 2005;140(4):362–7.CrossRef
15.
Zurück zum Zitat Genta RM, Spechler SJ, Kielhorn AF. The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology. Dis Esophagus. 2011;24:10–7.CrossRef Genta RM, Spechler SJ, Kielhorn AF. The Los Angeles and Savary-Miller systems for grading esophagitis: utilization and correlation with histology. Dis Esophagus. 2011;24:10–7.CrossRef
16.
Zurück zum Zitat Amato G, Limongelli P, Pascariello A, et al. Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication. Am J Surg. 2008;196(4):582–6.CrossRef Amato G, Limongelli P, Pascariello A, et al. Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication. Am J Surg. 2008;196(4):582–6.CrossRef
18.
Zurück zum Zitat Tolone S, Limongelli P, del Genio G, et al. Gastroesophageal reflux disease and obesity: do we need to perform reflux testing in all candidates to bariatric surgery? Int J Surg. 2014;12:173–7.CrossRef Tolone S, Limongelli P, del Genio G, et al. Gastroesophageal reflux disease and obesity: do we need to perform reflux testing in all candidates to bariatric surgery? Int J Surg. 2014;12:173–7.CrossRef
20.
Zurück zum Zitat Tutuian R, Vela MF, Balaji NS, et al. Esophageal function testing with combined multichannel intraluminal impedance and manometry: multicenter study in healthy volunteers. Clin Gastroenterol Hepatol. 2003;1(3):174–82.CrossRef Tutuian R, Vela MF, Balaji NS, et al. Esophageal function testing with combined multichannel intraluminal impedance and manometry: multicenter study in healthy volunteers. Clin Gastroenterol Hepatol. 2003;1(3):174–82.CrossRef
22.
Zurück zum Zitat Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(10):160–74.CrossRef Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27(10):160–74.CrossRef
23.
Zurück zum Zitat del Genio G, Tolone S, Rossetti G, et al. Total fundoplication does not obstruct the esophageal secondary peristalsis: investigation with pre- and postoperative 24-hour pH-multichannel intraluminal impedance. Eur Surg Res. 2008;40(2):230–4.CrossRef del Genio G, Tolone S, Rossetti G, et al. Total fundoplication does not obstruct the esophageal secondary peristalsis: investigation with pre- and postoperative 24-hour pH-multichannel intraluminal impedance. Eur Surg Res. 2008;40(2):230–4.CrossRef
25.
Zurück zum Zitat Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7(4):510–5.CrossRef Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review. Surg Obes Relat Dis. 2011;7(4):510–5.CrossRef
26.
Zurück zum Zitat Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59.CrossRef Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):749–59.CrossRef
28.
Zurück zum Zitat 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(11):1450–6.CrossRef 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(11):1450–6.CrossRef
33.
Zurück zum Zitat Olmi S, Caruso F, Uccelli M, et al. Laparoscopic sleeve gastrectomy combined with Rossetti fundoplication (R-sleeve) for treatment of morbid obesity and gastroesophageal reflux. Surg Obes Relat Dis. 2017;13(12):1945–50.CrossRef Olmi S, Caruso F, Uccelli M, et al. Laparoscopic sleeve gastrectomy combined with Rossetti fundoplication (R-sleeve) for treatment of morbid obesity and gastroesophageal reflux. Surg Obes Relat Dis. 2017;13(12):1945–50.CrossRef
34.
Zurück zum Zitat Rossetti G, del Genio G, Maffettone V, et al. Laparoscopic reoperation with total fundoplication for failed Heller myotomy: is it a possible option? Personal experience and review of literature. Int Surg. 2009;94(4):330–4.PubMed Rossetti G, del Genio G, Maffettone V, et al. Laparoscopic reoperation with total fundoplication for failed Heller myotomy: is it a possible option? Personal experience and review of literature. Int Surg. 2009;94(4):330–4.PubMed
37.
Zurück zum Zitat Del Genio GM, Collard JM. Acute complications of antireflux surgery. In: Ferguson MK, Fennerty MB, editors. Managing failed anti-reflux therapy. London: Springer Verlag; 2006. p. 67–77.CrossRef Del Genio GM, Collard JM. Acute complications of antireflux surgery. In: Ferguson MK, Fennerty MB, editors. Managing failed anti-reflux therapy. London: Springer Verlag; 2006. p. 67–77.CrossRef
38.
Zurück zum Zitat Karamanakos SN, Vagenas K, Kalfaretzos F. 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;247:401–7.CrossRef Karamanakos SN, Vagenas K, Kalfaretzos F. 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;247:401–7.CrossRef
40.
Zurück zum Zitat Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy-a “food limiting” operation. Obes Surg. 2008;18(10):1251–6.CrossRef Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy-a “food limiting” operation. Obes Surg. 2008;18(10):1251–6.CrossRef
41.
Zurück zum Zitat Oor JE, Roks DJ, Ünlü Ç, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67.CrossRef Oor JE, Roks DJ, Ünlü Ç, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis. Am J Surg. 2016;211(1):250–67.CrossRef
Metadaten
Titel
Sleeve Gastrectomy and Anterior Fundoplication (D-SLEEVE) Prevents Gastroesophageal Reflux in Symptomatic GERD
verfasst von
Gianmattia del Genio
Salvatore Tolone
Claudio Gambardella
Luigi Brusciano
Mariachiara Lanza Volpe
Giorgia Gualtieri
Federica del Genio
Ludovico Docimo
Publikationsdatum
07.03.2020
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 5/2020
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04427-1

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