Post-operative reflux esophagitis as a predictor of choice of restrictive operation in patients with metabolic syndrome

The purpose of this study was to conduct a comparative analysis of the retrospective results of laparoscopic sleeve gastrectomy (LSG), laparoscopic gastroplication (LGP) and laparoscopic fundogastroplication (LFGP) (simultaneous performance of fundoplication by Nissen and gastroplication) obtained at the follow-up period of 1 year, to evaluate and compare the effectiveness of prevention of short-term postoperative complications, which are manifested in the form of GERD, by performing preventive antireflux procedure in combination with restrictive bariatric surgery. Evaluation of the effectiveness and long-term effects of the presented restrictive operations was carried out on the basis of retrospective data obtained during the supervision of 46 patients with obesity and metabolic syndrome (men / women - 16/30, average age – 41.19±6.07, body weight – 128.26±7.37 kg, abdominal circumference – 133.4±4.71 cm, body mass index (BMI) – 42.66±2.41 kg/m2, I-III ASA). In the preoperative and postoperative periods, during consultations, in all patients measurements of anthropometric indicators were performed, laboratory data and results of instrumental research were considered. All metabolic procedures presented were performed at the basis of the Department of Surgery and Vascular Surgery of NMAPE named after P.L. Shupik in the period from 2016 to 2019. 13 patients underwent LSG, 20 – LGP and 13 - LFGP. In order to control the results, repeated consultations were carried out at 1, 3, 6 and 12 months of the postoperative period. The average duration of the operation was: LSG – 88.5±6.49 min, LGP - 120±5.42 min, LFGP – 135.38±7.48 min. The average period of hospitalization was: LSG – 3.2±0.63 days, LGP – 3.53±0.62 days, and LFGP – 3.5±0.67 days. After a year, the body mass index (BMI) was: LSG – 31.17±0.31 kg/m2, LGP – 32.48±0.23 kg/m2, LFGP – 32.43±0.21 kg/m2. According to the results of a repeated questio­ning of patients one year after the operation, 3 (23.07%) of the LSG group and 5 (25.0%) of the LGP group had symptoms of GERD, which failed to be eliminated with the help of conservative therapy, life quality of patients became significantly worse. In the group of patients who underwent LFGP, this complication was absent. After the control gastroscopy, 1 year after, de novo signs of reflux esophagitis were detected (according to the Los Angeles clas­sification): in the LSG group – 3 (23.07%) patients (2 - grade A and 1 - grade B), in the LGP group – 5 (25.0%) patients (3 – grade A and 2 – grade B). Among patients who underwent LFGP, there were no signs of reflux esophagitis. Considering the possible development of GERD and reflux esophagitis in one year after the restrictive surgery, the use of preventive measures consisting in the simultaneous performance of antireflux and metabolic operations is relevant, this is demonstrated by the example of LFGP. We recommend to give preference to simultaneous operations for the achievement of not only high rates of weight loss, but also for improvement of the quality of patients` life in the future.