Clinical Report: Effects of Sleeve Gastrectomy vs Roux-en-Y on Esophageal Function and GERD

Overview

This prospective study compared the impact of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on esophageal function and gastroesophageal reflux disease (GERD) in patients with severe obesity. Findings highlight differential effects on GERD symptoms, esophageal motility, and reflux patterns 12 months post-surgery, with LRYGB showing superior outcomes in GERD management.

Background

Obesity significantly increases the risk of GERD and other serious comorbidities. Bariatric surgery, including LSG and LRYGB, is the most effective treatment for severe obesity, but their effects on esophageal function and GERD vary. LSG is simpler but may worsen GERD due to anatomical and physiological changes, while LRYGB is more complex but generally improves GERD by reducing acid secretion and diverting bile. Understanding these effects is critical for optimizing surgical management.

Data Highlights

Key Findings

• LSG is associated with a potential increase in GERD symptoms postoperatively, likely due to decreased LES pressure and anatomical changes.
• LRYGB results in significant improvement or resolution of GERD symptoms by reducing acid secretion and diverting bile away from the esophagus.
• Esophageal manometry showed decreased LES pressure and possible motility impairment after LSG, whereas LRYGB preserved or improved these parameters.
• 24-hour MII-pH monitoring revealed increased acid and non-acid reflux episodes in some LSG patients, while LRYGB patients generally demonstrated normalized reflux profiles.
• Weight loss and reduction in intra-abdominal pressure contributed to GERD symptom improvement, more consistently observed after LRYGB.

Clinical Implications

Clinicians should carefully consider the risk of GERD exacerbation when selecting LSG for patients with severe obesity, especially those with preexisting reflux symptoms. LRYGB may be preferred in patients with significant GERD due to its superior efficacy in reducing reflux and preserving esophageal function. Comprehensive preoperative evaluation and postoperative monitoring using objective measures such as manometry and MII-pH monitoring are recommended to optimize patient outcomes.

Conclusion

This study underscores the differential impact of LSG and LRYGB on esophageal function and GERD, with LRYGB demonstrating superior outcomes in reflux control. Tailoring bariatric surgery choice to individual patient profiles can enhance long-term quality of life and reduce GERD-related complications.

References

1. 1 -- Bariatric Surgery and Weight Loss Outcomes
2. 2,3 -- Complications Affecting Esophageal Function Post-Bariatric Surgery
3. 4 -- GERD Incidence Post-LSG and Contributing Factors
4. 5 -- Mechanisms of Reflux Improvement Post-Weight Loss
5. 6 -- LRYGB as Superior GERD Treatment in Obese Patients
6. 7 -- Lyon Consensus 2.0 Criteria for GERD Diagnosis
7. 8 -- GERD-HRQL Questionnaire Validation
8. 9,10 -- Surgical Techniques for LSG and LRYGB