A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair
Abstract Background The effect of the laparoscopic sleeve gastrectomy (SG) on reflux symptoms is unclear. Many surgeons only offer SG to patients with minor or no reflux symptoms, fearing that patients with severe reflux symptoms will having worsening of their condition after SG. Many will also advo...
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| Veröffentlicht in: | Surgery for obesity and related diseases 2016-11, Vol.12 (9), p.1681-1688 |
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| creator | Snyder, Brad, M.D Wilson, Erik, MD Wilson, Todd, MD Mehta, Sheilendra, MD Bajwa, Kulvinder, MD Klein, Conniw, NP |
| description | Abstract Background The effect of the laparoscopic sleeve gastrectomy (SG) on reflux symptoms is unclear. Many surgeons only offer SG to patients with minor or no reflux symptoms, fearing that patients with severe reflux symptoms will having worsening of their condition after SG. Many will also advocate the need for crural repair at the time of SG to prevent de novo or worsening reflux symptoms. All the while, this is done without suitable data to make such conclusions. Objective To determine the impact of SG with or without hiatal hernia repair (HHR) on reflux symptoms. Setting University of Texas Health Sciences Center in Houston Methods The Gastrointestinal Symptom Rating Scale (GSRS) was determined in 100 consecutive, pre-operative SG who were then randomized into a crural repair group or non-repair group in a parallel design. They were subsequently followed up every three months for one year. We compared their demographics, body mass index (BMI), weight loss, presence and size of hiatal hernia, and GSRS for 12 months, comparing the groups’ reflux symptoms. Results We had 78% follow-up at a year and showed that there was a significant decrease in the GSRS within both groups (P |
| doi_str_mv | 10.1016/j.soard.2016.09.004 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1851291523</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1550728916306906</els_id><sourcerecordid>1851291523</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-3e334d4ab879c2314d7ccb029f8650ad0fdb218a46021933d130ec5ade95e9be3</originalsourceid><addsrcrecordid>eNqFkU9v1DAQxS0EoqXwCZCQj1wSxnacxAeQqop_UiUOwNly7NmulyQOtlNYPj1Ot3Dgwmns0XtvNL8h5DmDmgFrXx3qFEx0NS-fGlQN0Dwg56zv-qqTQjwsbymh6nivzsiTlA4AopUdf0zOeKd6JTk_J8sljWZ2YfK_0NEcvRmpDdNiop9vaMTduP6k6TgtOUyJ-pmmEfEW6Y1JOaIt3SNdTPY450R_-LynId7VsGa69yaXvD3G2ZsSthgfn5JHOzMmfHZfL8jXd2-_XH2orj-9_3h1eV3ZhjW5EihE4xoz9J2yXLDGddYOwNWubyUYBzs3cNabpgXOlBCOCUArjUMlUQ0oLsjLU-4Sw_cVU9aTTxbH0cwY1qRZLxlXTHJRpOIktTGkVHbWS_STiUfNQG-o9UHfodYbag1KF9TF9eJ-wDpM6P56_rAtgtcnAZY1bz1GnWzhZNH5jZx2wf9nwJt__Hb0s7dm_IZHTIewxrkQ1EwnrkF_3q69HZu1AloFrfgNulGoAQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1851291523</pqid></control><display><type>article</type><title>A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Snyder, Brad, M.D ; Wilson, Erik, MD ; Wilson, Todd, MD ; Mehta, Sheilendra, MD ; Bajwa, Kulvinder, MD ; Klein, Conniw, NP</creator><creatorcontrib>Snyder, Brad, M.D ; Wilson, Erik, MD ; Wilson, Todd, MD ; Mehta, Sheilendra, MD ; Bajwa, Kulvinder, MD ; Klein, Conniw, NP</creatorcontrib><description>Abstract Background The effect of the laparoscopic sleeve gastrectomy (SG) on reflux symptoms is unclear. Many surgeons only offer SG to patients with minor or no reflux symptoms, fearing that patients with severe reflux symptoms will having worsening of their condition after SG. Many will also advocate the need for crural repair at the time of SG to prevent de novo or worsening reflux symptoms. All the while, this is done without suitable data to make such conclusions. Objective To determine the impact of SG with or without hiatal hernia repair (HHR) on reflux symptoms. Setting University of Texas Health Sciences Center in Houston Methods The Gastrointestinal Symptom Rating Scale (GSRS) was determined in 100 consecutive, pre-operative SG who were then randomized into a crural repair group or non-repair group in a parallel design. They were subsequently followed up every three months for one year. We compared their demographics, body mass index (BMI), weight loss, presence and size of hiatal hernia, and GSRS for 12 months, comparing the groups’ reflux symptoms. Results We had 78% follow-up at a year and showed that there was a significant decrease in the GSRS within both groups (P<0.001); however, there was no difference between the groups (p=0.35). Age, starting BMI, percent excessive weight loss (%EWL), nor hiatal hernia size correlated with change in the GSRS score. The only variable that did impact outcome was the pre-operative GSRS. At 12 month, 38% of patients with a pre-operative GSRS less than the median score of the population had worsening of their symptoms compared to only 2% of patients who had pre-operative GSRS greater than the median. Overall, 19% had worsening reflux (5% de novo), 14% had no change, and a 66% reported an improvement in their symptoms. Conclusions These data suggest that a crural repair at the time of SG does not significantly reduce reflux symptoms compared to SG alone. Pre-operative patients with significant reflux symptoms have a more significant improvement in their symptoms after surgery compared to those patients who do not report significant reflux symptoms. The high incidence of reflux after SG observed in the current literature may be a result of this specific patient subpopulation that receives a SG because of surgeon bias and not an inherent property of the SG itself or the presence of a hiatal hernia.</description><identifier>ISSN: 1550-7289</identifier><identifier>EISSN: 1878-7533</identifier><identifier>DOI: 10.1016/j.soard.2016.09.004</identifier><identifier>PMID: 27989522</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Bariatric surgery ; Bariatric Surgery - methods ; Crural repair ; Gastrectomy - methods ; Gastroenterology and Hepatology ; Gastroesophageal Reflux - etiology ; Heartburn ; Hernia, Hiatal - surgery ; Herniorrhaphy - methods ; Hiatal hernia ; Humans ; Laparoscopy - methods ; Middle Aged ; Obesity, Morbid - surgery ; Operative Time ; Postoperative Complications - etiology ; Reflux ; Sleeve ; Sleeve gastrectomy ; Surgery ; Treatment Outcome ; Young Adult</subject><ispartof>Surgery for obesity and related diseases, 2016-11, Vol.12 (9), p.1681-1688</ispartof><rights>2016</rights><rights>Copyright © 2016. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-3e334d4ab879c2314d7ccb029f8650ad0fdb218a46021933d130ec5ade95e9be3</citedby><cites>FETCH-LOGICAL-c414t-3e334d4ab879c2314d7ccb029f8650ad0fdb218a46021933d130ec5ade95e9be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.soard.2016.09.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27989522$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Snyder, Brad, M.D</creatorcontrib><creatorcontrib>Wilson, Erik, MD</creatorcontrib><creatorcontrib>Wilson, Todd, MD</creatorcontrib><creatorcontrib>Mehta, Sheilendra, MD</creatorcontrib><creatorcontrib>Bajwa, Kulvinder, MD</creatorcontrib><creatorcontrib>Klein, Conniw, NP</creatorcontrib><title>A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair</title><title>Surgery for obesity and related diseases</title><addtitle>Surg Obes Relat Dis</addtitle><description>Abstract Background The effect of the laparoscopic sleeve gastrectomy (SG) on reflux symptoms is unclear. Many surgeons only offer SG to patients with minor or no reflux symptoms, fearing that patients with severe reflux symptoms will having worsening of their condition after SG. Many will also advocate the need for crural repair at the time of SG to prevent de novo or worsening reflux symptoms. All the while, this is done without suitable data to make such conclusions. Objective To determine the impact of SG with or without hiatal hernia repair (HHR) on reflux symptoms. Setting University of Texas Health Sciences Center in Houston Methods The Gastrointestinal Symptom Rating Scale (GSRS) was determined in 100 consecutive, pre-operative SG who were then randomized into a crural repair group or non-repair group in a parallel design. They were subsequently followed up every three months for one year. We compared their demographics, body mass index (BMI), weight loss, presence and size of hiatal hernia, and GSRS for 12 months, comparing the groups’ reflux symptoms. Results We had 78% follow-up at a year and showed that there was a significant decrease in the GSRS within both groups (P<0.001); however, there was no difference between the groups (p=0.35). Age, starting BMI, percent excessive weight loss (%EWL), nor hiatal hernia size correlated with change in the GSRS score. The only variable that did impact outcome was the pre-operative GSRS. At 12 month, 38% of patients with a pre-operative GSRS less than the median score of the population had worsening of their symptoms compared to only 2% of patients who had pre-operative GSRS greater than the median. Overall, 19% had worsening reflux (5% de novo), 14% had no change, and a 66% reported an improvement in their symptoms. Conclusions These data suggest that a crural repair at the time of SG does not significantly reduce reflux symptoms compared to SG alone. Pre-operative patients with significant reflux symptoms have a more significant improvement in their symptoms after surgery compared to those patients who do not report significant reflux symptoms. The high incidence of reflux after SG observed in the current literature may be a result of this specific patient subpopulation that receives a SG because of surgeon bias and not an inherent property of the SG itself or the presence of a hiatal hernia.</description><subject>Adult</subject><subject>Aged</subject><subject>Bariatric surgery</subject><subject>Bariatric Surgery - methods</subject><subject>Crural repair</subject><subject>Gastrectomy - methods</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastroesophageal Reflux - etiology</subject><subject>Heartburn</subject><subject>Hernia, Hiatal - surgery</subject><subject>Herniorrhaphy - methods</subject><subject>Hiatal hernia</subject><subject>Humans</subject><subject>Laparoscopy - methods</subject><subject>Middle Aged</subject><subject>Obesity, Morbid - surgery</subject><subject>Operative Time</subject><subject>Postoperative Complications - etiology</subject><subject>Reflux</subject><subject>Sleeve</subject><subject>Sleeve gastrectomy</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1550-7289</issn><issn>1878-7533</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9v1DAQxS0EoqXwCZCQj1wSxnacxAeQqop_UiUOwNly7NmulyQOtlNYPj1Ot3Dgwmns0XtvNL8h5DmDmgFrXx3qFEx0NS-fGlQN0Dwg56zv-qqTQjwsbymh6nivzsiTlA4AopUdf0zOeKd6JTk_J8sljWZ2YfK_0NEcvRmpDdNiop9vaMTduP6k6TgtOUyJ-pmmEfEW6Y1JOaIt3SNdTPY450R_-LynId7VsGa69yaXvD3G2ZsSthgfn5JHOzMmfHZfL8jXd2-_XH2orj-9_3h1eV3ZhjW5EihE4xoz9J2yXLDGddYOwNWubyUYBzs3cNabpgXOlBCOCUArjUMlUQ0oLsjLU-4Sw_cVU9aTTxbH0cwY1qRZLxlXTHJRpOIktTGkVHbWS_STiUfNQG-o9UHfodYbag1KF9TF9eJ-wDpM6P56_rAtgtcnAZY1bz1GnWzhZNH5jZx2wf9nwJt__Hb0s7dm_IZHTIewxrkQ1EwnrkF_3q69HZu1AloFrfgNulGoAQ</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Snyder, Brad, M.D</creator><creator>Wilson, Erik, MD</creator><creator>Wilson, Todd, MD</creator><creator>Mehta, Sheilendra, MD</creator><creator>Bajwa, Kulvinder, MD</creator><creator>Klein, Conniw, NP</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair</title><author>Snyder, Brad, M.D ; Wilson, Erik, MD ; Wilson, Todd, MD ; Mehta, Sheilendra, MD ; Bajwa, Kulvinder, MD ; Klein, Conniw, NP</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-3e334d4ab879c2314d7ccb029f8650ad0fdb218a46021933d130ec5ade95e9be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Bariatric surgery</topic><topic>Bariatric Surgery - methods</topic><topic>Crural repair</topic><topic>Gastrectomy - methods</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastroesophageal Reflux - etiology</topic><topic>Heartburn</topic><topic>Hernia, Hiatal - surgery</topic><topic>Herniorrhaphy - methods</topic><topic>Hiatal hernia</topic><topic>Humans</topic><topic>Laparoscopy - methods</topic><topic>Middle Aged</topic><topic>Obesity, Morbid - surgery</topic><topic>Operative Time</topic><topic>Postoperative Complications - etiology</topic><topic>Reflux</topic><topic>Sleeve</topic><topic>Sleeve gastrectomy</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Snyder, Brad, M.D</creatorcontrib><creatorcontrib>Wilson, Erik, MD</creatorcontrib><creatorcontrib>Wilson, Todd, MD</creatorcontrib><creatorcontrib>Mehta, Sheilendra, MD</creatorcontrib><creatorcontrib>Bajwa, Kulvinder, MD</creatorcontrib><creatorcontrib>Klein, Conniw, NP</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery for obesity and related diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Snyder, Brad, M.D</au><au>Wilson, Erik, MD</au><au>Wilson, Todd, MD</au><au>Mehta, Sheilendra, MD</au><au>Bajwa, Kulvinder, MD</au><au>Klein, Conniw, NP</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair</atitle><jtitle>Surgery for obesity and related diseases</jtitle><addtitle>Surg Obes Relat Dis</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>12</volume><issue>9</issue><spage>1681</spage><epage>1688</epage><pages>1681-1688</pages><issn>1550-7289</issn><eissn>1878-7533</eissn><abstract>Abstract Background The effect of the laparoscopic sleeve gastrectomy (SG) on reflux symptoms is unclear. Many surgeons only offer SG to patients with minor or no reflux symptoms, fearing that patients with severe reflux symptoms will having worsening of their condition after SG. Many will also advocate the need for crural repair at the time of SG to prevent de novo or worsening reflux symptoms. All the while, this is done without suitable data to make such conclusions. Objective To determine the impact of SG with or without hiatal hernia repair (HHR) on reflux symptoms. Setting University of Texas Health Sciences Center in Houston Methods The Gastrointestinal Symptom Rating Scale (GSRS) was determined in 100 consecutive, pre-operative SG who were then randomized into a crural repair group or non-repair group in a parallel design. They were subsequently followed up every three months for one year. We compared their demographics, body mass index (BMI), weight loss, presence and size of hiatal hernia, and GSRS for 12 months, comparing the groups’ reflux symptoms. Results We had 78% follow-up at a year and showed that there was a significant decrease in the GSRS within both groups (P<0.001); however, there was no difference between the groups (p=0.35). Age, starting BMI, percent excessive weight loss (%EWL), nor hiatal hernia size correlated with change in the GSRS score. The only variable that did impact outcome was the pre-operative GSRS. At 12 month, 38% of patients with a pre-operative GSRS less than the median score of the population had worsening of their symptoms compared to only 2% of patients who had pre-operative GSRS greater than the median. Overall, 19% had worsening reflux (5% de novo), 14% had no change, and a 66% reported an improvement in their symptoms. Conclusions These data suggest that a crural repair at the time of SG does not significantly reduce reflux symptoms compared to SG alone. Pre-operative patients with significant reflux symptoms have a more significant improvement in their symptoms after surgery compared to those patients who do not report significant reflux symptoms. The high incidence of reflux after SG observed in the current literature may be a result of this specific patient subpopulation that receives a SG because of surgeon bias and not an inherent property of the SG itself or the presence of a hiatal hernia.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27989522</pmid><doi>10.1016/j.soard.2016.09.004</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Aged Bariatric surgery Bariatric Surgery - methods Crural repair Gastrectomy - methods Gastroenterology and Hepatology Gastroesophageal Reflux - etiology Heartburn Hernia, Hiatal - surgery Herniorrhaphy - methods Hiatal hernia Humans Laparoscopy - methods Middle Aged Obesity, Morbid - surgery Operative Time Postoperative Complications - etiology Reflux Sleeve Sleeve gastrectomy Surgery Treatment Outcome Young Adult |
| title | A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair |
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