Mansour Ahmed Mohammed Farid Mahmoud, Ghazal Abd El Hamid Ahmed, Kassem Mohamed Ibrahim, Ugliono Elettra, Morino Mario, ElKeleny Mostafa Refaie
Alexandria University, Alexandria, Egypt.
University of Turin, Turin, Italy.
Obes Surg. 2025 May;35(5):1702-1717. doi: 10.1007/s11695-025-07818-4. Epub 2025 Apr 14.
Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most commonly performed bariatric surgical procedures. The effectiveness of these operations on weight control is well established; however, their impact on esophageal physiology is still under evaluation. The aim of this study is to evaluate the consequences of LSG and LRYGB on esophageal physiology, especially concerning reflux.
This prospective study involved 30 patients with severe obesity; 15 underwent LSG, and 15 had LRYGB. Conducted between 2021 and 2023 in Turin, Italy, the study employed preoperative and 1-year postoperative assessments of esophageal function using conventional esophageal manometry, 24-h multichannel intraluminal impedance-pH (MII-pH), upper gastrointestinal series, upper endoscopy, and a validated questionnaire to assess outcomes related to esophageal and lower esophageal sphincter (LES) functions and reflux.
Both groups experienced significant reductions in weight and body mass index, with p-values < 0.001 for both measures. The LRYGB group achieved a significantly higher percentage of excess weight loss compared to the LSG group, with a p-value of < 0.001. In the LSG group, GERD symptoms remained unchanged postoperatively (p = 0.687), with 26.7% using proton pump inhibitors (PPIs) before and after surgery, while in the LRYGB group, GERD symptoms and PPIs use significantly decreased from 53.3 to 6.7% (p = 0.016). Quality of life improved significantly in both groups, with a p-value of 0.001. In the LRYGB group only, esophagitis significantly decreased from 53.3 to 6.7% (p = 0.007), and barium studies showed a significant reduction in reflux signs from 66.7% preoperatively to none postoperatively (p = 0.002). Multichannel intraluminal impedance-pH monitoring revealed significant reductions in reflux metrics for LRYGB group only: total refluxes decreased from 29.0 to 15.0, acidic refluxes from 12.0 to 8.0, and the DeMeester score from 4.70 to 3.70 (p = 0.026, 0.033, and 0.029, respectively). Regarding the manometric parameters, significant changes were observed in the LSG group: total LES length decreased from 34.0 to 31.33 mm (p = 0.027) and residual pressure increased from 2.0 to 4.0 mmHg (p = 0.012), also peristaltic wave amplitude decreased from 98.20 to 52.93 mmHg (p < 0.001), while in the LRYGB group, only the LES residual pressure significantly increased from 2.0 to 4.0 mmHg (p = 0.006).
LSG and LRYGB are effective for weight loss and improving quality of life. Sleeve gastrectomy controls reflux, with new cases being rare. Advanced diagnostics are key when standard tests are insufficient.
腹腔镜袖状胃切除术（LSG）和腹腔镜Roux-en-Y胃旁路术（LRYGB）是最常施行的减肥手术。这些手术在控制体重方面的有效性已得到充分证实；然而，它们对食管生理功能的影响仍在评估之中。本研究的目的是评估LSG和LRYGB对食管生理功能的影响，尤其是与反流相关的影响。
这项前瞻性研究纳入了30例重度肥胖患者；15例行LSG，15例行LRYGB。该研究于2021年至2023年在意大利都灵进行，采用传统食管测压、24小时多通道腔内阻抗-pH（MII-pH）监测、上消化道造影、上消化道内镜检查以及一份经过验证的问卷对食管功能进行术前和术后1年的评估，以评估与食管和食管下括约肌（LES）功能及反流相关的结果。
两组患者的体重和体重指数均显著降低，两项指标的p值均<0.001。与LSG组相比，LRYGB组实现了显著更高的超重减轻百分比，p值<0.001。在LSG组中，术后胃食管反流病（GERD）症状无变化（p = 0.687），术前和术后使用质子泵抑制剂（PPI）的患者比例均为26.7%，而在LRYGB组中，GERD症状和PPI的使用从53.3%显著降至6.7%（p = 0.016）。两组患者的生活质量均显著改善，p值为0.001。仅在LRYGB组中，食管炎从53.3%显著降至6.7%（p = 0.007），钡餐检查显示反流征象从术前的66.7%显著降至术后的无（p = 0.002）。多通道腔内阻抗-pH监测显示，仅LRYGB组的反流指标显著降低：总反流次数从29.0次降至15.0次，酸性反流次数从12.0次降至8.0次，DeMeester评分从4.70降至3.70（p分别为0.026、0.033和0.029）。关于测压参数，在LSG组中观察到显著变化：LES总长度从34.0毫米降至31.33毫米（p = 0.027），残余压力从2.0毫米汞柱升至4.0毫米汞柱（p = 0.012），蠕动波幅度也从98.20毫米汞柱降至52.93毫米汞柱（p<0.001），而在LRYGB组中，仅LES残余压力从2.0毫米汞柱显著升至4.0毫米汞柱（p = 0.006）。
LSG和LRYGB在减肥和改善生活质量方面是有效的。袖状胃切除术能控制反流，新发病例罕见。当标准检查不足时，先进的诊断方法是关键。
