ReviewLaparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis

•There is a slight trend toward an increased prevalence of GERD symptoms following LSG.•Objective esophageal function tests following LSG demonstrate paradoxical results.•There is a need for standardization of the technique of LSG and further prospectively studies.•Bariatric surgeons should carefully evaluate any potential preoperative GERD-related complaints.

BackgroundThe effect of sleeve gastrectomy (SG) on the prevalence of gastroesophageal reflux disease (GERD) remains unclear. We aimed to outline the currently available literature.Data SourcesAll relevant databases were searched for publications examining the effect of laparoscopic SG on GERD. Primary outcome measure was change in prevalence of GERD symptoms, antireflux medication use, and esophageal function tests. Secondary outcomes were prevalence of new-onset GERD and esophagitis. Thirty-three articles were included. Eleven studies used questionnaires to assess changes in the prevalence of GERD symptoms, with a risk difference in prevalence of 4.3%. Eight studies used esophageal function tests, with paradoxical results. Pooled incidence of new-onset GERD symptoms was 20%, with a strong suggestion of heterogeneity. New-onset esophagitis ranged from 6.3% to 63.3%.ConclusionsBecause of high heterogeneity among available studies and paradoxical outcomes of objective esophageal function tests, the exact effect of laparoscopic SG on the prevalence of GERD remains unanswered. Surgeons should carefully evaluate preoperative GERD symptoms when choosing the proper bariatric technique.