Bariatric Surgery and the Mechanisms of Gastroesophageal Reflux Disease.

The association between obesity and gastroesophageal reflux disease (GERD) is very well known and the pathophysiology of GERD is not completely understood but is likely to have a multifactorial nature especially after bariatric procedures. The current editorial summarizes the principal mechanisms involved in the reflux disease following different bariatric procedures. Laparoscopic adjustable gastric banding could reduce the gastroesophageal reflux in the short term in some cases, but overeating will inevitably lead to enlargement of the pouch with loss of its antireflux properties. Although the laparoscopic Roux-en-Y gastric bypass was considered the gold standard procedure for obese patients with reflux disease, many patients had at least one complication within their follow-up period. One anastomosis gastric bypass remains a controversial procedure for GERD, especially when it is proposed as revisional surgery after laparoscopic sleeve gastrectomy. As revisional surgery, either single anastomosis duodeno-ileostomy (SADI) or duodenal switch (DS) have little or no impact on GERD and in our experience the indication for SADI/DS is a valid option in case of absence of any symptoms of reflux. The effect of sleeve for GERD is contradictory. For those with moderate reflux, since specific procedure guidelines are missing, surgical treatment for morbid obese patients must be selected according to the clinical characteristics of the patient, his eating habits and patient willingness. It should be based on a preoperative workup with shared decision making, with the double purpose of treating both GERD and obesity.