Successfully treat post-sleeve gastrectomy GERD, the cause of the problem must first be identified
https://doi.org/10.17238/2072-3180-2023-66-74
Abstract
Introduction. Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery in the world. Gastroesophageal reflux disease (GERD) is most common post-SG complication. Post-SG patients with GERD refractory to proton pump inhibitors usually undergo anatomy-altering Roux-en-Y gastric bypass surgery which becomes the only treatment as usual.
Purpose: to analyze the factors for the development of GERD after SG and the surgical options for treatment. To propose an algorithm for the surgical treatment of GERD, depending on the cause of its development.
Materials and methods. A search and analysis of the literature in the Medline database (pubmed.org) evaluating the postoperative results of primary SG surgery was carried out. The review included meta-analyses, randomized and non-randomized trials. Key words in the search were: sleeve gastrectomy, gastroesophageal reflux disease, hiatal hernia, gastric bypass. A review of the methods of surgical treatment of GERD, depending on the etiological factors, was carried out.
Conclusion. Increased intragastric pressure, esophageal dysmotility, lower esophageal sphincter dystonia, concomitant hiatal hernia and the shape of the sleeve are major GERD factors. There is no universal method of surgical treatment GERD after SG, which has absolute effectiveness. The approach to solving the problem of GERD should be differentiated, that is, take into account the factors of its development. Repairing a hiatal hernia or gastric deformities such as strictures and dilations may help improve symptoms. With dysfunction of the lower esophageal sphincter, gastric bypass options should be considered, the most effective of which is RYGB.
About the Authors
A. S. Tsepkovsky
S.M. Kirov Military Medical Academy (Moscow branch)
Russian Federation
Russian Federation
Tsepkovsky Alexander Sergeevich
Moscow, M.Cherkizovskaia 7, 107392
A. L. Levchuk
S.M. Kirov Military Medical Academy (Moscow branch); N. I. Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Alexandr Lvovich Levchuk – MD, PhD, Director’s Advisor
105203, Nizhnyaia Pervomaiskaia 70, Moscow
M. S. Baleev
Clinical Hospital № 30 of Nizhny Novgorod
Russian Federation
Russian Federation
Baleev Mikhail Sergeevich – PhD, Surgeon of the Surgical Departmen
Nizhny Novgorod, st. Berezovskaya 85 A, 603157
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For citations:
Tsepkovsky A.S., Levchuk A.L., Baleev M.S. Successfully treat post-sleeve gastrectomy GERD, the cause of the problem must first be identified. Moscow Surgical Journal. 2023:66-74. (In Russ.) https://doi.org/10.17238/2072-3180-2023-66-74
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