Background

Sleeve gastrectomy (SG) is the most commonly performed bariatric surgery in the United States; however, incidence of de novo gastroesophageal reflux disease (GERD) after SG approaches 40%. While preoperative GERD or preexisting hiatal hernia aid surgeons with regard to counseling, there are no other patient-specific factors that will help determine risk for de novo GERD post-SG.

Methods

Intraoperative manometry was performed at the time of SG in adult patients without history of preexisting reflux or hiatal hernia. Measurements of gastroesophageal (GEJ) distensibility at multiple time points during SG were obtained (pre-dissection, post-dissection, and post-SG). Patients answered the GERD quality of life questionnaire preoperatively and postoperatively. Using results from manometry and the questionnaire, the aim is to identify those at risk for development of reflux.

Results

The distensibility of the GEJ increased significantly from pre-dissection (1.950 mm Hg) to post-SG (3.850 mm Hg) (p=0.013), as well as from post-dissection (2.500 mm Hg) to post-SG (3.850 mm Hg) (p=0.003). There was no correlation between preoperative distensibilities and GERD quality of life scores at 3 or 6 months postoperatively. A 6 months postoperatively, there is a positive correlation between post-SG distensibility and GERD quality of life scores that approaches statistical significance (R=0.575, p=0.064) (Fig. 1).

Conclusions

Intraoperative manometry provides information regarding the physiology of the GEJ at different time points during SG that may relate to development of GERD. Additional follow-up data for this pilot study is actively being acquired.