Reflux disease following primary sleeve gastrectomy: risk factors and possible causes

Updates Surg. 2023 Jun;75(4):967-977. doi: 10.1007/s13304-023-01477-9. Epub 2023 Feb 27.


One of the most severe side effects of sleeve gastrectomy (SG) is the development or aggravation of reflux disease. This study investigates the effect of SG on the development of reflux disease and the variables that may impact this development. In addition, trends in revision surgery, weight, and comorbidity are examined among patients with reflux disease and SG and those without reflux disease and SG. This study includes 3379 individuals without reflux disease who had primary SG and were followed for three years. The demographic characteristics, comorbidities, technical features, and complications of SG were analyzed. Data were collected by the German Bariatric Surgery Registry (GBSR). 860 (25.45%) Group A patients had reflux disease following SG (Group B: no reflux after SG; 74.55%). Patients with reflux disease had longer operating times (83.8 min vs. 77.5 min, p < 0.001) and longer postoperative hospital admissions (6 days vs. 5.5 days). In group A, the %EWL was substantially greater than in group B (64.1 vs. 61.1%). 42 patients were converted from SG to RYGB (4.88%), 2 had hiatoplasty, and 5 got Endostim. There is no significant variation in perioperative complications (p value > 0.05). The incidence of complete remission of sleep apnea was higher in group A than in group B (p = 0.013; 50% vs. 44.8%). Other comorbidities were not substantially different. Reflux illness after SG is still poorly understood, despite much research. Technical and preoperative variables may promote its development. However, these assumptions remain theoretical and are not confirmed by scientific data. The majority of patients may be successfully treated using non-invasive methods, although sometimes further surgery is necessary. Despite our results and the literature, this subject is intriguing for further research.

Keywords: Perioperative complications; Reflux; Revisional bariatric surgery; Sleeve gastrectomy.

MeSH terms

  • Bariatric Surgery* / adverse effects
  • Bariatric Surgery* / methods
  • Gastrectomy / adverse effects
  • Gastrectomy / methods
  • Gastric Bypass* / methods
  • Gastroesophageal Reflux* / surgery
  • Humans
  • Obesity, Morbid* / complications
  • Obesity, Morbid* / surgery
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome