Effect of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms

Background
Laparoscopic sleeve gastrectomy (LSG) is one of the most well-known, safe, and effective bariatric procedures worldwide with the lowest incidence of complications and satisfactory results. Altered gastric anatomy following LSG is likely to induce upper gastrointestinal (UGI) symptoms.
Patients and methods
The validated Rome III criteria symptom questionnaire for UGI symptoms was used for 30 patients who underwent LSG. Before surgery, patients were tested for in stool, eradicated and underwent UGI endoscopy for identification of any pathological finding. Symptoms were analyzed separately and UGI endoscopy was performed postoperatively to classify the findings and correlate these with UGI symptoms.
Results
Before LSG, 60% of the patients were asymptomatic, 40% had gastroesophageal reflux disease (GERD), and 6.7% had dyspepsia. All were subjected to UGI endoscopy and no significant finding was found in 40%, gastritis in 60%, esophagitis was found in 20%, duodenitis was found in 13.3%, and duodenal ulcer was found in 6.7% of patients. Forty percent of patients were positive and 60% of patients were negative. After a median follow-up of 6 months, 93.3% of the patients complained of UGI symptoms, the most prevalent being dyspepsia (66.7%) (<0.001). The prevalence of GERD did not differ before and after LSG, but GERD symptoms disappeared in 83.3% of patients. Vomiting increased significantly, occurring in 20% (=0.030) of all patients, associated with GERD. A significant correlation was found between GERD and hiatus hernia in all patients (<0.001) and a correlation was also found between vomiting and incompetent cardia in 66.7% of patients (=0.029).
Conclusion
After a median follow-up of 6 months following LSG, dyspepsia, rather than GERD, was the main complaint. Hiatus hernia was strongly related to GERD and incompetent cardia was related to vomiting taking into consideration that all patients who developed vomiting had associated GERD.