Effect of Gastric Sleeve Migration on Weight Loss and Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy.

Abstract

Laparoscopic sleeve gastrectomy (LSG) is one of the most popular bariatric procedures because of its simplicity and good weight loss effects. However, transhiatal sleeve migration (THSM) after LSG is currently considered an aggravating factor for postoperative weight regain and gastroesophageal reflux disease (GERD). Thus, our aims in this study were to clarify the incidence of THSM after LSG and to evaluate the relationships between THSM parameters and clinical outcomes. In this paper, we introduce a novel definition of THSM after LSG. We enrolled 107 patients with severe obesity who underwent LSG. We collected their clinical data at baseline and 1 year after LSG. All the patients were routinely examined with esophagogastroduodenoscopy (EGD) and evaluated for GERD severity using the Los Angeles classification. They underwent a routine computed tomography examination, and the THSM length and volume were measured at a computer workstation. We then comprehensively analyzed the THSM parameters and clinical features of weight loss and GERD. The mean percentage of total weight loss (%TWL) in this cohort was 26.2%. The Los Angeles classification data, determined by EGD evaluation, indicated an increase in the number of patients with grades B and C GERD from 6 to 11 at 1 year after LSG, and THSM occurred in 16 patients (15.0%). Postoperative antacid administration rate also significantly increased (3.7% vs. 21.8%, p < 0.001). The mean THSM length and volume were 23.7 ± 13.1 mm and 9.6 ± 13.1 mL, respectively. THSM length significantly correlated with THSM volume (r = 0.700 and p = 0.002) and negatively correlated with %TWL (r = -0.620 and p = 0.010). In this cohort, the patients with a THSM length > 20 mm did not achieve a high %TWL at 1 year after LSG (27.3% ± 3.8% vs. 21.4% ± 3.9%, p = 0.010), and patients with a longer THSM length had a higher antacid consumption. THSM lengths > 20 mm had the greatest effect on weight loss and GERD progression after LSG. We successfully stratified the THSM cases into subclinical and clinical categories based on THSM length and the patients' clinical features.