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- Title
Quantifying physiologic parameters of the gastroesophageal junction during robotic sleeve gastrectomy and identifying predictors of post-sleeve gastroesophageal reflux disease.
- Authors
Greenberg, Jacques A.; Palacardo, Federico; Edelmuth, Rodrigo C. L.; Egan, Caitlin E.; Lee, Yeon Joo; Dakin, Gregory; Zarnegar, Rasa; Afaneh, Cheguevara; Bellorin, Omar
- Abstract
Background: Sleeve gastrectomy is among the most commonly-performed procedures for morbid obesity. However, patients occasionally develop post-sleeve gastroesophageal reflux disease (GERD). Identifying patients most at risk for this complication remains difficult. We aimed to correlate intra-operative physiologic measurements of the lower esophageal sphincter (LES) at the gastroesophageal junction (GEJ) during robotic sleeve gastrectomy in an attempt to identify predictors of post-sleeve GERD symptoms. Methods: A retrospective chart review of a prospectively maintained database identified 28 patients in whom robotic sleeve gastrectomy was performed utilizing EndoFLIP™ technology between January and September 2021. Intraoperative LES measurements at the GEJ including cross-sectional area (CSA), distensibility index (DI), intra-balloon pressure, and high-pressure zone (HPZ length) were correlated with post-operative GERD. Results: GEJ CSA, pressure, and DI increased over the course of the surgery (CSA pre-op: 31 (IQR 19.3–39.5) mm2 vs. post-op: 67 (IQR 40.8–95.8) mm2, p < 0.001; pressure: 25.8 (IQR 20.2–33.1) mmHg vs. 31.5 (IQR 28.9–37.0) mmHg, p = 0.007; DI 1.1 (IQR 0.8–1.8) mm2/mmHg vs. 2.0 (IQR 1.2–3.0) mm2/mmHg, p = < 0.001), whereas HPZ length decreased (2.5 (IQR 2.5–3) cm vs. 2.0 (IQR 1.3–2.5) cm, p = 0.022). Twenty-three patients (82.1%) completed a post-operative GERD questionnaire. Fifteen (65.2%) had no GERD symptoms before or after surgery; 5 (21.7%) reported new post-sleeve GERD symptoms; 3 (13.0%) reported exacerbation of pre-existing GERD symptoms. Patients with new or worsening GERD symptoms had higher post-sleeve DIs (3.2 (IQR 1.9–4.5) mm2/mmHg vs. 1.5 (IQR 1.2–2.4) mm2/mmHg, p = 0.024) and lower post-sleeve LES pressures (29.9 (IQR 26.3–32.9) mmHg vs. 35.2 (IQR 31.0–38.0) mmHg, p = 0.023) than those without. Conclusions: An increase in GEJ CSA, pressure, and DI, and a decrease in GEJ length can be expected during robotic sleeve gastrectomy. Patients with new or worsening post-sleeve GERD symptoms have higher post-sleeve DI and lower post-sleeve LES pressure than their asymptomatic counterparts.
- Subjects
SLEEVE gastrectomy; GASTROESOPHAGEAL reflux; MORBID obesity; ESOPHAGOGASTRIC junction; ROBOTICS; SURGICAL robots; DATABASES
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2023, Vol 37, Issue 2, p1543
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-022-09450-0