A multicenter retrospective cohort study on factors associated with the occurrence of gastroesophageal reflux disease after sleeve gastrectomy

Abstract:

Background and Aims Sleeve gastrectomy (SG) has become the most widely performed bariatric procedure worldwide, but postoperative gastroesophageal reflux disease (GERD) remains a major concern. This multicenter study aimed to identify independent risk factors associated with GERD after SG to guide preoperative assessment and intraoperative management.Methods Clinical data of 672 patients who underwent SG between January 2020 and December 2022 in six bariatric centers and completed a 12-month follow-up were retrospectively analyzed. Demographic characteristics, esophagogastric junction (EGJ) integrity graded by the AFS system, operative parameters, and postoperative outcomes were compared between patients with and without GERD. Multivariate logistic regression was used to identify predictors of postoperative GERD.Results The overall incidence of GERD after SG was 24.7% (166/672). Multivariate analysis revealed that a preoperative BMI>35 kg/m² (OR=1.68, P=0.033), EGJ integrity AFS grade>2 (OR=2.90, P=0.006), and preoperative reflux symptoms (OR=2.44, P=0.030) were independent risk factors for GERD. A staple line more than 1 cm from the angle of His (OR=0.45, P<0.001) and a bougie size>36 Fr (OR=0.08, P=0.001) were protective factors.Conclusion High BMI, impaired EGJ integrity, and preoperative reflux symptoms significantly increase the risk of GERD after SG, whereas adequate preservation of the His angle and appropriate bougie calibration may reduce it. Comprehensive preoperative EGJ assessment and standardized surgical techniques are essential for minimizing postoperative reflux.