Effect of Pyloric Balloon Dilatation on GERD after LSG

Background: Laparoscopic Sleeve Gastrectomy (LSG) has taken the bariatric surgical scene by storm over the past 5 to 10 years. LSG effectively treats most of the co-morbid medical problems associated with obesity. The one exception is Gastro-Esophageal Reflux Disease (GERD). Patients with GERD experience less resolution of their symptoms after LSG than do patients with Laparoscopic Adjustable Gastric Band (LAGB), even when the LABG patients lost less weight overall. Methods: Pyloric balloon dilatation was done to 20 morbidly obese patients undergoing sleeve gastrectomy and the results were compared to another group of 20 LSG patients in which no pyloromyotomy was done. Results: The pre-operative GERD prevalence was 45%, and by the end of the study was 80%, yet the difference was not significant (p-value=0.3). The incidence of GERD resolution post-operative was 5%, while the new onset GERD cases were 40%. Conclusion: Pyloromyotomy has reduced the gastric pressure to an extent that was adequate to relieve heart burn and other symptoms of GERD but only in the immediate postoperative period, was not sustained for a long period.