Background

Gastroesophageal reflux disease (GERD) occurs frequently after laparoscopic sleeve gastrectomy (LSG) but research on preoperative predictors of its occurrence is limited. This study investigates the predictive ability of preoperative endoscopic Hill Classification for developing GERD post-LSG.  

Methods

We included patients undergoing LSG in 2017-2022 who had preoperative Esophagogastroduodenoscopy (EGD) with documentation of Hill classification (grades I-IV). The presence of a hiatal hernia was categorized as Grade IV. The presence of GERD after surgery was determined based on patient symptoms and need for regular antacid medication intake. Multivariable analysis was utilized to assess the predictive ability of the endoscopic Hill classification.

Results

Among 167 patients who underwent LSG during the study period, 93 (55.7%) had pre-operative EGD with documented Hill Classification, and 30 (18%) had Hill grade III or IV. 39 (41.9%) patients had GERD at baseline, and 49 (52.7%) at postoperative follow-up at 1 year post-op with 51% developing new-onset GERD. On multivariable analysis, Hill grade III or IV was independently associated with GERD at baseline (aOR: 9.3, 95%CI: 1.3-67.5, p = 0.028), however, it was not predictive for persistent or new-onset GERD post-LSG at 1, 2 or 3 years. Concurrent hiatal hernia repair had no significant impact on postoperative GERD occurrence or resolution.

Conclusions

Endoscopic Hill classification is inadequate as a sole predictor of GERD after LSG, suggesting that other patient and operation factors may be contributing. Further research is essential to identify reliable predictors for postoperative GERD after LSG to improve patient selection and surgical planning.