Background

Sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB) remain the most common bariatric procedures performed in the United States. However, patients undergoing sleeve gastrectomy are at increased risk of developing or exacerbating gastroesophageal reflux disease (GERD) postoperatively. We analyzed the effect of bariatric surgery on patients who were at elevated risk of GERD.

Methods

Methods Bariatric surgery patients at Temple University Hospital from 2018 to 2023 were reviewed. 92 completed both an initial and 1-year post-operative GERD Impact Scale (GIS) questionnaire. We analyzed their perioperative testing and procedures, including upper GI fluoroscopy, high-resolution esophageal manometry, pH impedance, EGD, and presence of intra-operative hiatal hernia. The impact of the type of surgery on the change in their GIS scores was analyzed using ANOVA testing.

Results

50 patients underwent RYGB and 42 underwent sleeve gastrectomy. RYGB patients had significantly improved GIS scores compared to sleeve patients (-4.00 vs +0.88, p<0.005). After separately accounting for presence of pre-operative reflux and dysmotility on imaging and manometry, and intraoperative hiatal hernia repair with two-way ANOVA, the difference was still significant (p = 0.016, 0.010, 0.031, 0.003 respectively). However, no significance was found after accounting for Demeester score (p = .111).

Conclusions

Our results validate the difference in GERD symptom improvement between patients undergoing sleeve gastrectomy and RYGB. Accounting for results of manometry testing and hiatal hernia repair does not significantly impact this difference, suggesting that these components may be unnecessary. Further work is needed to assess the ideal preoperative algorithm for identifying severe postoperative reflux complications.