Journal Review in Bariatric Surgery: Worsening or De Novo GERD following Vertical Sleeve Gastrectomy
May 19, 2022
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In this insightful discussion, the hosts explore the puzzling relationship between bariatric surgery and gastroesophageal reflux disease (GERD). They question whether weight loss alone can alleviate GERD symptoms and delve into the impact of vertical sleeve gastrectomy on these conditions. The nuances of hiatal hernia repairs and their effect on postoperative GERD are highlighted, as well as contradictions in existing research. The importance of ongoing monitoring and tailored care for patients is emphasized, revealing the complexities of surgical outcomes.
The podcast discusses the potential for worsening or de novo GERD symptoms following vertical sleeve gastrectomy, challenging the assumption that weight loss alone suffices for symptom relief.
It emphasizes the importance of conducting thorough preoperative evaluations and considering surgical options like gastric bypass for patients with significant pre-existing GERD symptoms.
Deep dives
Exploration of Fellowship Opportunities
The discussion introduces exciting fellowship positions available for surgical residents, encouraging them to engage actively in innovative projects aimed at enhancing surgical education. This includes various initiatives such as specialty oral board reviews, medical student education, and a trauma surgery video atlas. The two-year fellowship program, slated to begin in July 2022, will allow residents to spearhead significant research efforts and contribute to ongoing podcast and video content. Applications for these fellowships are due by May 25th, underscoring the urgency and significance of participating in these promising opportunities.
GERD and Bariatric Surgery Insights
The episode analyzes the complex relationship between gastroesophageal reflux disease (GERD) and vertical sleeve gastrectomy, highlighting ongoing debates among surgeons on the procedure's efficacy for patients with pre-existing GERD. Limited data suggests that while weight loss might alleviate some symptoms, postoperative GERD may worsen or emerge de novo in certain patients. Specific recommendations include considering gastric bypass procedures for those with significant GERD symptoms or esophagitis preoperatively, as opposed to solely relying on sleeve gastrectomy. Ultimately, the lack of correlations between subjective symptoms and objective GERD indicators emphasizes the need for more thorough preoperative evaluations.
Systematic Review of Hiatal Hernia Repairs
A systematic review examines the effects of performing hiatal hernia repairs alongside sleeve gastrectomy on postoperative GERD outcomes, revealing significant variations in results across multiple studies. Notably, while the incidence of GERD symptoms decreased from approximately 55% to 30% post-operatively, the presence of hiatal hernia during initial assessment was inconsistent across studies in terms of type and repair method. Findings indicated that performing repairs during sleeve gastrectomy could lead to considerable remission rates for GERD. However, the discrepancies in study methodologies and sample sizes highlight the necessity for better standardization and further research to universally understand the relationship between hernia repairs and GERD management post-surgery.
Subjective and objective GERD are common amongst bariatric surgery patients. Is weight loss alone enough to improve GERD symptoms? Is the vertical sleeve gastrectomy really associated with worsening GERD? What technical factors of the vertical sleeve gastrectomy lead to improved or worsening GERD? Listen to find out!
Effect of Concomitant Laparoscopic Sleeve Gastrectomy and Hiatal Hernia Repair on Gastroesophageal Reflux in Patients with Obesity: A Systematic Review and Meta-Analysis https://pubmed.ncbi.nlm.nih.gov/34254259/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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