Midterm outcomes of laparoscopic sleeve gastrectomy for gastroesophageal reflux disease in patients with obesity

Laparoscopic sleeve gastrectomy (LSG) is a widely adopted surgical treatment for obesity. However, its impact on gastroesophageal reflux disease (GERD) remains controversial, with reports of both improvement and worsening of pre-existing GERD or de novo symptom development. To evaluate the mid-term effects of LSG on GERD. We retrospectively analyzed data from 135 patients who underwent primary LSG between June 2019 and April 2021. Among these, 123 patients completed a mean follow-up of 41.0 ± 5.3 months, including the Gastroesophageal Reflux Disease-Questionnaire (GERD-Q) before and after surgery. The prevalence of preoperative GERD was 43.1 %. Within the overall cohort, there was no significant change in GERD-Q score ( P = 0.710). However, in a subgroup analysis, patients without GERD preoperatively demonstrated a worsening in mean GERD-Q scores after surgery (from 6.5 ± 0.5 to 7.5 ± 1.7, P < 0.001), and 34.3 % of these patients developed de novo symptoms. Notably, patients with pre-existing GERD demonstrated a significant improvement in mean GERD-Q scores after surgery (9.0 ± 1.2 to 7.8 ± 1.9, P < 0.001), and 54.7 % of these patients reported complete resolution of symptoms. In the subgroup of asymptomatic patients with an intraoperatively identified hiatal hernia (HH), concomitant HHR was associated with stable GERD-Q scores and a lower incidence of de novo GERD compared with those without HHR (20.0 % vs. 36.7 %). Endoscopic follow-up showed that the prevalence of esophagitis increased from 6.5 % to 26.5 % in all cohort. LSG demonstrated a divergent effect on GERD. While pre-existing GERD symptoms may improve, patients without GERD are at significant risk of developing de novo symptoms. Concomitant HHR mitigates the risk of de novo GERD in asymptomatic patients with intraoperatively identified HH. Future research should include objective GERD assessments.