Effect Of Laparoscopic Sleeve Gastrectomy On Gastroesophageal Reflux And Its Risk Factors

Objective: To evaluate the effects of laparoscopic sleeve gastrectomy on gastroesophageal reflux with objective examination indexes such as esophageal high-resolution manometry and esophageal 24 h pH monitoring,and to analyze the risk factors for postoperative gastroesophageal reflux.Methods: Retrospective analysis of medical records of patients undergoing laparoscopic sleeve gastrectomy(LSG)from January 2015 to September 2018 in the People's Hospital of Xinjiang Uygur Autonomous Region,high-resolution esophageal manometry,esophageal 24 h pH impedance monitoring,etc.The indicators were scored according to the preoperative DeMeester score.The preoperative and postoperative contrast indexes were compared to evaluate the effect of laparoscopic sleeve gastrectomy on gastroesophageal reflux.Grouped again according to the postoperative DeMeester score,regression analysis led to risk factors for postoperative pathological acid exposure.Results: A total of 85 cases were included in the study.According to the pre-DeMeester score,43 patients with normal acid exposure(DeMeester score <14.7),42 patients with pathological acid exposure(DeMeester score ?14.7),and preoperative BMI for normal obesity patients were 39.75±6.23.The month was reduced to30.40±5.27;the pathological group was 40.20±6.22 before operation and decreased to30.52±5.31 at 6 months after operation.The difference was statistically significant(P<0.05).The LES pressure in the pathological group was 11.61±4.15 mmHg before operation and decreased to 10.18±2.94 mmHg after operation.The difference was statistically significant(P<0.05).Fifteen patients with new pathogenic acid exposure after operation were regrouped,44 patients with DeMeester score ?14.7,and 41 patients with DeMeester score <14.7.Regression analysis showed preoperative high DeMeester score and low LES resting pressure.It was an independent risk factor for pathological acid reflux after surgery(P<0.05).Conclusions:(1)LSG can further reduce the resting pressure of LES in patients with pathological acid exposure before surgery,but has no significant effect on other esophageal dynamics;(2)high DeMeester score and low LESresting pressure before surgery After the occurrence of pathological acid reflux independent risk factors;(3)preoperative LES resting pressure measurement,DeMeester score determination,the potential value of clinical treatment of obesity surgery options.