Generally isolated sleeve gastrectomy is not considered as good option in a patient with GERD. What are the options available?
Ideally any procedure which does not cause reflux like RNY Gastric bypass or sleeve with pyloric sphincter preservation like DJB.However cruroplasty with sleeve also being considered.
I highly recommend LRYGB (R en Y gastric bypass).
there are a lot of study to support this method .
Dear Dr SHAH
Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass:
Abstract
10-year results of laparoscopic sleeve gastrectomy
Daniel M. Felsenreich, M.D.a, Felix B. Langer, M.D.a, Ronald Kefurt, M.D.a, Peter Panhofer, M.D.a, Martin Schermann, M.D.b, Philipp Beckerhinn, M.D.c,
Christoph Sperker, M.D.b, Gerhard Prager, M.D.a,*
aDivision of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria bDepartment of Surgery, Hospital Rudolfstiftung, Vienna, Austria
cDepartment of Surgery, Hospital Hollabrunn, Hollabrunn, Austria
Received October 28, 2015; accepted February 21, 2016
Background: With promising short-term results, laparoscopic sleeve gastrectomy (SG) has become the second most frequently performed bariatric procedure worldwide. Aside from a growing number of reports covering up to 10 years of follow-up, only limited data have been published so far on long-term results.
Objectives: The aim of the study was to present a 10-year follow-up for SG.
Setting: University hospital setting, Austria.
Methods: We present the first complete 10-year follow-up of 53 consecutive patients who underwent SG before 2006. In this multicenter study, weight loss success, weight regain, and revisional surgery were analyzed beside Bariatric Analysis and Reporting Outcome System (BAROS) scores.
Results: A mean maximum percent excess weight loss of 71 25% (percent total weight loss: 28 15%) was reached at a median of 12 (range 12–120) months after SG. At 10 years, a mean percent excess weight loss of 53 25% was achieved by 32 patients, corresponding to a percent total weight loss of 26.3 13.4%. Nineteen of the 53 patients (36%) were converted to Roux-en-Y gastric bypass (n 1⁄4 18) or duodenal switch (n 1⁄4 1) due to significant weight regain (n 1⁄4 11), reflux (n 1⁄4 6), or acute revision (n 1⁄4 2) at a median of 36 months. Two patients died at 3 and 101 months postoperatively, unrelated to SG. A total of 31 patients (59%) suffered from weight regain of 10 kg or more, among them 24 patients (45%) with 15 kg or more, 16 patients (30%) with 20 kg or more, and 7 patients (13%) with 25 kg or more weight regain from nadir. Mean BAROS score was 2.4 2.2 at 10 years follow-up, classifying SG as “fairly efficient.”
Conclusion: Within a long-term follow-up of 10 years or more after SG, a high incidence of both significant weight regain and intractable reflux was observed, leading to conversion, most com- monly to Roux-en-Y gastric bypass. (Surg Obes Relat Dis 2016;]:00–00.) r 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
You can propose for an obese patient who present a GERD even a gastric banding or a sleeve gastrectomy or a gastric bypass. GERD is frequently due to high intra abdominal pressure which could decrease or totally disappear with weight loss after bariatric surgery. The main question is to know if GERD is associated with hiatal hernia or esophageal histological lesions due GERD like intestinal metaplasia. In those cases, there is a contre indication to perform a sleeve gastrectomy and it could be better to choice a gastric bypass.
I agree with the bypass choice. But the question is - do these patients also need a formal hiatal hernia repair as well?
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