Short term detection of de novo gastroesophageal reflux disease after laparoscopic sleeve gastrectomy.

Abstract

Background: The escalating global prevalence of obesity presents a significant public health concern, driving increased rates of obesity-associated comorbidities. Timely identification and management are essential to reduce long-term health and economic consequences.

Objective: This study sought to evaluate the short-term emergence of gastroesophageal reflux disease (GERD) in patients with severe obesity undergoing laparoscopic sleeve gastrectomy (LSG) early in the first 6 months postoperatively.

Methods: We conducted a prospective case series involving 60 patients with severe obesity who received LSG at the Bariatric Surgery Unit, Department of Surgery, Ain Shams University Hospitals (June 2018-June 2021). Postoperative follow-up included clinical evaluation and diagnostic testing to detect new-onset GERD.

Results: GERD developed in 26.7% of patients (16 of 60) following LSG. Based on these findings, LSG should be avoided in individuals with preoperative evidence of erosive esophagitis, Barrett's esophagus, or an incompetent lower esophageal sphincter (LES), where Roux-en-Y gastric bypass may represent a more suitable alternative. For selected patients with a BMI of 30-35 and associated comorbidities, LSG combined with anti-reflux procedures or concurrent hiatal hernia repair could be considered.

Conclusion: The study reinforces the need for thorough preoperative evaluation, including routine upper gastrointestinal endoscopy, to screen for GERD, hiatal hernia, and premalignant conditions. Careful patient selection and individualized surgical planning remain critical to optimizing outcomes after bariatric surgery.