Muhammed Ashraf Memon^1,2,3,4,5 | Emma Osland^6,7 | Rossita M. Yunus⁸ | Khorshed Alam⁹ | Zahirul Hoque¹⁰ | Shahjahan Khan^1,11

¹School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia,

²Sunnybank Obesity Centre & South & East Queensland Surgery (SEQS), McCullough Centre, Suite 9, 259 McCullough Street, Sunnybank, QLD, Australia,

³Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia,

⁴Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia,

⁵Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK,

⁶Department of Dietetics and Food Services, Royal Brisbane and Women’s Hospital, Herston, QLD 4019, Australia,

⁷Department of Human Movements and Nutrition, University of Queensland, Brisbane, QLD, Australia,

⁸Institute of Mathematical Sciences, Universiti Malaya, Kuala Lumpur, Malaysia,

⁹School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD 4350, Australia,

¹⁰School of Mathematics, Physics and Computing, University of Southern Queensland, Toowoomba, QLD, Australia, and

¹¹School of Science and Engineering, Asian University of Bangladesh, Dhaka, Bangladesh.

DOI: 10.1093/dote/doad063

Diseases of the Esophagus

Volume 37, Issue 3

Published Date: March 2024 | Article number: doad063

Summary

To compare 5-year gastroesophageal reflux outcomes following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) based on high quality randomized controlled trials (RCTs). We conducted a sub-analysis of our systematic review and meta-analysis of RCTs of primary LVSG and LRYGB procedures in adults for 5-year post-operative complications (PROSPERO CRD42018112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane Risk of Bias Tool 2 and GRADE. Four RCTs were included (LVSG n = 266, LRYGB n = 259). An increase in adverse GERD outcomes were observed at 5 years postoperatively in LVSG compared to LRYGB in all outcomes considered: Overall worsened GERD, including the development de novo GERD, occurred more commonly following LVSG compared to LRYGB (OR 5.34, 95% CI 1.67 to 17.05; p = 0.02; I² = 0%; (Moderate level of certainty); Reoperations to treat severe GERD (OR 7.22, 95% CI 0.82 to 63.63; p = 0.06; I² = 0%; High level of certainty) and non-surgical management for worsened GERD (OR 3.42, 95% CI 1.16 to 10.05; p = 0.04; I² = 0%; Low level of certainty) was more common in LVSG patients. LVSG is associated with the development and worsening of GERD symptoms compared to LRYGB at 5 years postoperatively leading to either introduction/increased pharmacological requirement or further surgical treatment. Appropriate patient/surgical selection is critical to minimize these postoperative risks.