Introduction
Laparoscopic sleeve gastrectomy has been accepted as an option for surgical treatment of obesity. After surgery, some patients present reflux symptoms associated with endoscopic esophagitis, therefore PPI’s treatment must be indicated.

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Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients.

This study aims to review the obesity literature in order to assess the impact of bariatric surgery on quality of life and the between-study variation by examining the standardized mean magnitude of effect in change in the levels of quality of life. The following databases EMBASE, PubMed, PsycINFO, CINAHL, the Cochrane Library and Web of Science were systematically searched for studies examining change in quality of life in adults receiving bariatric surgery for obesity. Seventy-two studies were included with a total of 9,433 participants treated for obesity with bariatric surgery. The average impact of bariatric surgery on quality of life corresponded to an effect size of 0.88 (95% CI: 0.80-0.96), indicating that bariatric surgery has a significant positive influence on quality of life in general. The impact varied considerably across studies with bariatric surgery showing a significantly greater positive influence on physical quality of life compared to mental quality of life. Bariatric surgery is effective in improving quality of life, especially when looking at physical well-being. Greater focus on the psychological well-being of the person undergoing surgery for obesity may lead to a better post-surgery prognosis for more people.

The impact of bariatric surgery on quality of life: a systematic review and meta-analysis

https://www.soard.org/article/S1550-7289(15)00040-4/pdf

Revised sleeve gastrectomy (re-sleeve)

Gastroesophageal reflux disease is commonly present in obese patients. 1–3 In patients undergoing gastric bypass, the incidence of GERD is as high as 50% to 100%. Therefore, it is very important to evaluate preoperatively the presence of reflux symptoms and endoscopic esophagitis to choose the best treatment of both pathologic conditions: GERD and obesity. There are publications reporting the strategy for treating concomitant hiatal hernia or GERD disease and bariatric procedures for obese patients. Laparoscopic sleeve gastrectomy (LSG) is a frequently used alternative procedure for surgical treatment of obesity. This technique modifies the anatomy of the esophagogastric junction (EGJ) converting it in a straight tubular segment and partially sectioning the sling fibers that may affect the lower esophageal sphincter (LES) mechanism. Consequently, some patients present reflux symptoms associated with endoscopic esophagitis and therefore PPÍs treatment must be indicated. After SG LES incompetence is present in 85% of patients and thus could promote pathologic reflux. However, others have suggested that reflux esophagitis improves after SG; therefore it is a very controversial point. There are very few data regarding GERD or hiatal hernia after SG including endoscopic objective evaluation of reflux. In this paper, we present our experience regarding the frequency of gastroesophageal reflux disease after SG and review the available literature concerning this point.

Gastroesophageal reflux disease after sleeve gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is becoming a very common bariatric procedure, based on several advantages it carries over more complex bariatric procedures such as gastric bypass or duodenal switch (DS), and a better quality of life over gastric banding. However, in the long-term follow-up, weight loss failure and intractable severe reflux after primary LSG can necessitate further surgical interventions, and revisional sleeve gastrectomy (ReSG) can represent an option to correct these. From October 2008 to June 2013, 36 patients underwent an ReSG for progressive weight regain, insufficient weight, or severe gastroesophageal reflux in ‘La Casamance’ Private Hospital. All patients with weight loss failure after primary LSG underwent radiological evaluation. If Gastrografin swallow showed a huge unresected fundus or an upper gastric pouch dilatation, or if the computed tomography (CT) scan volumetry revealed a gastric tube superior to 250 cc, ReSG was proposed. Thirty-six patients (34 women, two men; mean age 41.3 years) with a body mass index (BMI) of 39.9 underwent ReSG. Thirteen patients (36.1 %) had their original LSG surgery performed at another hospital and were referred to us for weight loss failure. Twenty-four patients (66.6 %) out of 36 had a history of gastric banding with weight loss failure. Thirteen patients (36.1 %) were super-obese (BMI > 50) before primary LSG. The LSG was realized for patients with morbid obesity with a mean BMI of 47.1 (range 35.4–77.9). The mean interval time from the primary LSG to ReSG was 34.5 months (range 9–67 months). The indication for ReSG was insufficient weight loss for 19 patients (52.8 %), weight regain for 15 patients (41.7 %), and 2 patients underwent ReSG for invalidating gastroesophageal reflux disease. In 24 cases the Gastrografin swallow results were interpreted as primary dilatation, and in the remaining 12 cases results were interpreted as secondary dilatation. The CT scan volumetry was realized in 21 cases, and it has revealed a mean gastric volume of 387.8 cc (range 275–555 cc). All 36 cases were completed by laparoscopy with no intraoperative incidents. The mean operative time was 43 min (range 29–70 min), and the mean hospital stay was 3.9 days (range 3–16 days). One perigastric hematoma was recorded. The mean BMI decreased to 29.2 (range 20.24–37.5); the mean percentage of excess weight loss was 58.5 % (±25.3) (p < 0.0004) for a mean follow-up of 20 months (range 6–56 months). The ReSG may be a valid option for failure of primary LSG for both primary or secondary dilatation. Long-term results of ReSG are awaited to prove efficiency. Further prospective clinical trials are required to compare the outcomes of ReSG with those of Roux en Y Gastric Bypass or DS for weight loss failure after LSG.

Revised sleeve gastrectomy: another option for weight loss failure after sleeve gastrectomy

Few studies have investigated changes in health-related quality of life (HRQOL) in surgical patients who have undergone a laparoscopic sleeve gastrectomy. Prospective data were obtained from 78 consecutive patients undergoing laparoscopic sleeve gastrectomy (LSG; mean age, 42.4 years; mean body weight, 131 kg; mean body mass index (BMI), 47 kg/m(2) (24.4% of superobese patients)). Two HRQOL questionnaires were administered preoperatively and 12 months postsurgery: the generic Medical Outcomes Study Short Form-36 and the weight-specific IWQOL-Lite questionnaire. Excess weight loss at 12 months was 57.18%. No mortality was recorded. HRQOL scores revealed a significant improvement in all areas of both questionnaires. However, changes in HRQOL were not associated consistently with amount of weight loss. Laparoscopic sleeve gastrectomy is an effective and safe procedure, with positive changes in health-related quality of life as well as weight reduction. A fruitful area for future research is the investigation of long-term changes in HRQOL after LSG.

Ronnette L. Kolotkin

Papers

Improvement in Quality of Life After Laparoscopic Sleeve Gastrectomy