Ricerc@Sapienza

Methods: GERD was evaluated by the Modified Italian Gastroesophageal reflux disease—Health-Related Quality of Life
(MI-GERD-HRQL) questionnaire, pH-manometry, endoscopy, and Rx-esophagogram, before and 12 months after
surgery. Based on these exams, patients without GERD underwent LSG, and patients with GERD underwent LGB.
Results: Thirteen and six patients underwent LSG and LGB, respectively. After LSG, the only statistically significant
difference observed at pH-manometry was the median DeMeester score, from 5.7 to 22.7 (P = .0026). De novo GERD
occurred in 6 patients (46.2%), with erosive esophagitis in one. The median MI-GERD-HRQL score improved from 3 to
0. Overall, nine patients underwent LGB, but three were lost to follow-up. Preoperative pH-manometry changed the
surgical indication from LSG to LGB in 7 out of 9 patients (77.8%). Six patients who underwent LGB completed the study,
and at pH-manometry, statistically significant differences were observed in the percentage of total acid exposure time,
with the number of reflux episodes lasting >5 minutes and DeMeester score (P = .009). The median MI-GERD-HRQL
score improved from 6.5 to 0. Statistically significant differences were not observed at endoscopy and Rx-esophagogram
findings in both groups.
Conclusions: LSG has a negative impact on GERD, even in patients without preoperative GERD. LGB confirmed to be
the intervention of choice in patients with GERD. Preoperative pH-manometry may identify patients with silent GERD,
to candidate themto LGB rather than LSG. pH-manometry should be used more liberally to establish the correct surgical
indication on objective grounds.