MAGETIC SPHINCTER AUGMENTION VERSUS SUBTOTAL GASTRECTOMY WITH ROUX-EN-Y RECONSTRUCTION FOR THE TREATMENT OF POST-SLEEVE GASTRECTOMY GASTROESOPHAGEAL REFLUX DISEASE

Introduction: Obesity affects over one-third of Americans and can be treated with bariatric surgery, most commonly sleeve gastrectomy. Sleeve gastrectomy may lead to gastroesophageal reflux disease (GERD) in 8.6-18.4% of patients, some of which can be refractory to medical management and have limited options. Surgical options include Magnetic Sphincter Augmentation (MSA) and Subtotal Gastrectomy with Roux-en-Y Reconstruction (SGRY). A comparative analysis of MSA and SGRY for post-sleeve gastrectomy reflux was performed to evaluate post-operative outcomes.

Methods: A retrospectively maintained prospectively gathered database from 2018 to 2023 was conducted on patients that had undergone MSA or SGRY for the indication of GERD post-sleeve gastrectomy. Differences between patient characteristics, GERD assessments including Health-Related Quality of Life questionnaire (HRQL) and Reflux Symptom Index, and procedure outcomes were collected and analyzed based on surgery type.

Results: A total of 92 patients (85 female, 7 male) met inclusion criteria. The study included 17 patients in the MSA group, 71 in the SGRY group, and 4 patients who underwent both procedures. The average pre-operative BMI was 33.3. When compared to MSA, SGRY patients presented with higher BMI (34.2 vs 29.4, p=0.013), pre-operative GERD-HRQL (52 vs 35, p=0.046), Reflux Symptom Index (28 vs 14, p=0.017), and a greater overall change in GERD-HRQL score (-44 vs -27, p=0.078). Additionally, SGRY patients demonstrated a decrease in mean post-operative DeMeester score (13.9 vs 44.2, p=0.040) with 50% (N=22) achieving normalization compared to 20% (N=10) in the MSA group.

Conclusion: While MSA remains a viable surgical alternative, our study indicates that SGRY can produce better symptom control and decreased acid exposure over MSA for patients suffering from post-sleeve gastrectomy GERD.