Analysis of the efficacy of sleeve gastrectomy, one-anastomosis gastric bypass and single anastomosis sleeve ileal in the treatment of obesity combined with gastroesophageal reflux disease

doi:10.3877/cma.j.issn.2095-8765.2025.01.002

Abstract

Abstract:

Objective

The quality of life of obese patients is frequently reduced due to comorbid gastroesophageal reflux disease (GERD), and bariatric metabolic surgery has been widely used as an effective treatment. Currently, whether GERD is complicating the postoperative period of different weight loss procedures is still controversial, making the choice of surgical procedure a key issue in the clinical management of obese patients. In this study, we retrospectively analysed the postoperative efficacy of sleeve gastrectomy, single-anastomosis gastric bypass and sleeve gastrectomy combined with gastrojejunostomy, and their complications of GERD in obese patients at our centre.

Methods

We included 95 patients with obesity combined with GERD who underwent bariatric surgery in the Department of Bariatric and Metabolic Surgery, Gulou Hospital, School of Medicine, Nanjing University, from June 2022 to June 2023, and divided them into three groups according to the surgical methods, namely, sleeve gastrectomy (SG) (35 patients), one-anastomosis gastric bypass (OAGB) (28 patients), and single anastomosis sleeve ileal (SASI) (32 patients). The weight, body mass index (BMI), change in waist circumference, and percentage of excess weight loss (EWL%) of the patients in the three groups were compared before surgery, at 6 months after surgery, and at 1 year after surgery, and the patients’ comorbidities of diabetes mellitus, GERD, and esophagitis were compared before and after surgery.

Results

Significant body mass reduction was recorded at 6 and 12 months after surgery in the 3 groups; in addition, patients in the SG group had significant postoperative discomfort, including acid reflux and abdominal distension, whereas those who underwent SASI had more postoperative diarrhea, and the incidence of postoperative gastric colic was higher in the patients in the OAGB group; there was a significant difference in the improvement of GERD among the 3 groups postoperatively (P<0.05); according to postoperative gastroscopy as well as scale assessment results, GERD remission in patients in the SASI group was significantly better than that in the SG and OAGB groups.

Conclusion

Compared with OAGB and SG, SASI is the optimal choice for the treatment of obesity-combined GERD, but its long-term effect remains to be observed. In addition, the size of gastrointestinal anastomosis and the choice of the length of biliopancreatic limb need more careful experience and reasonable evidence-based research.

Key words: Bariatric and metabolic surgery, Gastroesophageal Reflux Disease, Obesity

Xing Kang, Xuefeng Xia, Hang Yu, Xuehui Chu, Xitai Sun. Analysis of the efficacy of sleeve gastrectomy, one-anastomosis gastric bypass and single anastomosis sleeve ileal in the treatment of obesity combined with gastroesophageal reflux disease[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2025, 12(01): 10-16.

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References 33

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指标	SG组（35例）	OAGB组（28例）	SASI组（32例）	P值
年龄（岁，±s）	27.05±7.6	33.6±5.3	34.9±6.8	0.203
性别（男性/女性）	19/16	15/13	17/15	0.312
BMI（kg/m²，±s）	34.7±6.2	39.5±4.9	38.2±5.8	0.214
体质量（kg，±s）	107.7±23.8	102.8±17.3	105.5±18	0.059
腰围（cm，±s）	118.0±12.9	115.0±10.7	116.8±11.2	0.187
臀围（cm，±s）	110.8±7.3	112.6±6.3	108.7±8.9	0.317
糖化血红蛋白（%，±s）	6.0±1.2	5.9±2.4	6.9±2.3	0.235
血红蛋白（g/L，±s）	129.4±8.6	117.9±7.1	126.7±19.1	0.187
空腹血糖（mmol/L，±s）	6.2±2.1	7.1±2.2	7.2±2.9	0.218
白蛋白（g/L，±s）	41.5±3.5	41.8±3.4	44.5±4.6	0.282
甘油三酯（mmol/L，±s）	2.1±2.2	2.0±1.2	2.3±1.9	0.201
维生素B12（pg/ml，±s）	493.5±188.1	490.1±221.9	513.3±273.5	0.264
25羟基维生素D（±s）	15.2±4.3	13.1±7.1	14.3±5.1	0.882
合并症[例（%）]
2型糖尿病	12（40）	9（45）	12（60）	0.128
GERD	9（25.7）	10（35.7）	12（37.5）	0.719
OSAHS	11（36.6）	13（60）	11（55）	0.728
GERD-Q（分，±s）	9.81±1.28	9.51±0.98	10.11±1.08	0.619

指标	SG组（35例）	OAGB组（28例）	SASI组（32例）	P值
年龄（岁，±s）	27.05±7.6	33.6±5.3	34.9±6.8	0.203
性别（男性/女性）	19/16	15/13	17/15	0.312
BMI（kg/m²，±s）	34.7±6.2	39.5±4.9	38.2±5.8	0.214
体质量（kg，±s）	107.7±23.8	102.8±17.3	105.5±18	0.059
腰围（cm，±s）	118.0±12.9	115.0±10.7	116.8±11.2	0.187
臀围（cm，±s）	110.8±7.3	112.6±6.3	108.7±8.9	0.317
糖化血红蛋白（%，±s）	6.0±1.2	5.9±2.4	6.9±2.3	0.235
血红蛋白（g/L，±s）	129.4±8.6	117.9±7.1	126.7±19.1	0.187
空腹血糖（mmol/L，±s）	6.2±2.1	7.1±2.2	7.2±2.9	0.218
白蛋白（g/L，±s）	41.5±3.5	41.8±3.4	44.5±4.6	0.282
甘油三酯（mmol/L，±s）	2.1±2.2	2.0±1.2	2.3±1.9	0.201
维生素B12（pg/ml，±s）	493.5±188.1	490.1±221.9	513.3±273.5	0.264
25羟基维生素D（±s）	15.2±4.3	13.1±7.1	14.3±5.1	0.882
合并症[例（%）]
2型糖尿病	12（40）	9（45）	12（60）	0.128
GERD	9（25.7）	10（35.7）	12（37.5）	0.719
OSAHS	11（36.6）	13（60）	11（55）	0.728
GERD-Q（分，±s）	9.81±1.28	9.51±0.98	10.11±1.08	0.619

组别	例数	呕吐	反酸	腹泻	胃绞痛	腹胀
SG组	35	20（57.1）	24（68.6）	8（22.9）	7（20）	14（40）
OAGB组	28	11（39.3）	10（35.7）	8（28.6）	9（32.1）	3（10.7）
SASI组	32	5（15.6）	3（9.3）	10（31.3）	5（15.6）	2（6.3）
P值		0.001	0.007	0.002	0.008	0.213

组别	例数	呕吐	反酸	腹泻	胃绞痛	腹胀
SG组	35	20（57.1）	24（68.6）	8（22.9）	7（20）	14（40）
OAGB组	28	11（39.3）	10（35.7）	8（28.6）	9（32.1）	3（10.7）
SASI组	32	5（15.6）	3（9.3）	10（31.3）	5（15.6）	2（6.3）
P值		0.001	0.007	0.002	0.008	0.213

指标	SG组（35例）	OAGB组（28例）	SASI组（32例）	P值
体质量（kg）
术前	107.7±23.8	102.8±17.3	105.5±18.0	0.059
术后6个月	81.03±11.1	84.13±12.7	79.32±11.2	0.012
术后12个月	71±12.3	73.2±10.1	70.1±9.3	0.003
BMI（kg/m²）
术前	34.7±6.2	39.5±4.9	38.2±5.8	0.214
术后6个月	30.9±5.3	32.1±3.7	28.4±4.5	0.009
术后12个月	22.0±3.2	25.9±4.1	21.3±2.8	0.002
%TWL
术后6个月	21.4±2.7	19.3±2.2	17.87±4.2	0.006
术后12个月	27.4±4.2	25.2±3.3	27.83±5.3	0.045
%EBMIL
术后6个月	62.3±31.08	52.2±12.1	63.1±37.1	0.004
术后12个月	81.1±29.3	75.09±24.9	84.3±17.9	0.019
GERD-Q（分）
术前	9.8±1.3	9.51±1.0	10.1±1.1	0.619
术后6个月	8.3±1.3	7.2±0.9	6.8±1.2	0.004
术后12个月	7.8±1.2	5.3±1.0	5.3±1.0	0.001

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