AUMENTO DEL REFLUJO GASTROESOFÁGICO TRAS GASTRECTOMÍA VERTICAL (MANGA GÁSTRICA): UNA REVISIÓN BIBLIOGRÁFICA
DOI:
https://doi.org/10.56238/arev7n11-307Palabras clave:
Gastrectomía en Manga, Manga Gástrica, Cirugía Bariátrica, Enfermedad por Reflujo Gastroesofágico, Obesidad, Complicaciones PostoperatoriasResumen
La obesidad constituye uno de los mayores desafíos de salud pública contemporáneos, con una prevalencia en aumento progresivo y un impacto directo en la morbilidad y mortalidad a nivel mundial. Entre los enfoques terapéuticos, la cirugía bariátrica representa el método más eficaz y duradero para la reducción de peso y la remisión de las comorbilidades metabólicas. En este contexto, la gastrectomía vertical (GV), o manga gástrica, se ha consolidado como la técnica bariátrica más utilizada en todo el mundo, debido a su sencillez técnica, seguridad y preservación del tránsito gastrointestinal. Sin embargo, se observa una creciente asociación entre la GV y el desarrollo o empeoramiento de la enfermedad por reflujo gastroesofágico (ERGE). Las alteraciones anatómicas y fisiológicas resultantes de la resección del fundus gástrico y la modificación del ángulo de His contribuyen a la disminución de la distensibilidad gástrica, el aumento de la presión intragástrica y la disfunción del esfínter esofágico inferior, lo que compromete el mecanismo antirreflujo. Si bien la gastrectomía en manga (GM) es una técnica eficaz para la pérdida de peso y el control metabólico, el alto riesgo de reflujo posoperatorio exige una evaluación preoperatoria exhaustiva y una cuidadosa selección de los candidatos. El manejo multidisciplinario y la mejora técnica son fundamentales para optimizar los resultados y minimizar las complicaciones funcionales a largo plazo.
Descargas
Referencias
GBD 2021 Colaboradores adultos do IMC. Prevalência global, regional e nacional de sobrepeso e obesidade em adultos, 1990-2021, com previsões para 2050: um estudo de previsão para o Global Burden of Disease Study 2021.
Lanceta. 2025 8 de março; 405(10481):813-838. DOI: 10.1016/S0140-6736(25)00355-1. Epub 2025 3 de março. Errata em: Lancet. 23 de agosto de 2025; 406(10505):810. DOI: 10.1016/S0140-6736(25)01722-2. PMID: 40049186; PMCID: PMC11920007.
Kheniser K, Saxon DR, Kashyap SR. Long-Term Weight Loss Strategies for Obesity. J Clin Endocrinol Metab. 2021 Jun 16;106(7):1854-1866. doi: 10.1210/clinem/dgab091. PMID: 33595666; PMCID: PMC8427732.
Maki KC, Kirkpatrick CF, Allison DB, Gadde KM. Pharmacotherapy for obesity: recent evolution and implications for cardiovascular risk reduction. Expert Rev Endocrinol Metab. 2023 Sep-Nov;18(4):307-319. doi: 10.1080/17446651.2023.2209176. Epub 2023 May 18. PMID: 37199542.
Abdul Wahab R, le Roux CW. A review on the beneficial effects of bariatric surgery in the management of obesity. Expert Rev Endocrinol Metab. 2022 Sep;17(5):435-446. doi: 10.1080/17446651.2022.2110865. Epub 2022 Aug 10. PMID: 35949186.
Poggi L, Bernui GM, Romani DA, Gavidia AF, Poggi LA. Persistent and De Novo GERD After Sleeve Gastrectomy: Manometric and pH-Impedance Study Findings. Obes Surg. 2023;33(1):87-93. doi:10.1007/s11695-022-06126-5
Dowgiałło-Gornowicz N, Lech P. The real occurrence of gastroesophageal reflux disease after sleeve gastrectomy - a prospective pH-monitoring study. Wideochir Inne Tech Maloinwazyjne. 2024 Jun;19(2):205-210. doi: 10.5114/wiitm.2024.138521. Epub 2024 Apr 3. PMID: 38973794; PMCID: PMC11223549.
Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y, Schultes B, Beglinger C, Drewe J, Schiesser M, Nett P, Bueter M. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial. JAMA. 2018 Jan 16;319(3):255-265. doi: 10.1001/jama.2017.20897. PMID: 29340679; PMCID: PMC5833546.
Palermo M, Serra E, Duza G. N-SLEEVE GASTRECTOMY: AN OPTION FOR OBESITY AND GERD. Arq Bras Cir Dig. 2019 Dec 20;32(4):e1482. doi: 10.1590/0102-672020190001e1482. PMID: 31859934; PMCID: PMC6918749.
Liu G, Wang P, Ran S, Xue X, Meng H. Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy. Front Endocrinol (Lausanne). 2024 Oct 29;15:1463567. doi: 10.3389/fendo.2024.1463567. Erratum in: Front Endocrinol (Lausanne). 2025 Jun 05;16:1630859. doi: 10.3389/fendo.2025.1630859. PMID: 39534257; PMCID: PMC11554513.
Gastrectomia vertical: resultados da literatura. Maedica (Bucur). Março de 2024; 19(1):137-146. DOI: 10.26574/maedica.2024.19.1.137. PMID: 38736914; PMCID: PMC11079741.
Aili A, Maimaitiming M, Maimaitiyusufu P, Tusuntuoheti Y, Li X, Cui J, Abudureyimu K. Gastroesophageal reflux related changes after sleeve gastrectomy and sleeve gastrectomy with fundoplication: A retrospective single center study. Front Endocrinol (Lausanne). 2022 Nov 18;13:1041889. doi: 10.3389/fendo.2022.1041889. PMID: 36465617; PMCID: PMC9716307.
Cao K, Zhai Z, Shi X, Jin Y, Ye C, Wu Y, Sun M, Wang J, Wang Z, Han J. The short-term effect of laparoscopic sleeve gastrectomy with his angle reconstruction (LSG-His) on gastroesophageal reflux disease. BMC Gastroenterol. 2025 Aug 21;25(1):611. doi: 10.1186/s12876-025-04216-z. PMID: 40841928; PMCID: PMC12369119.
Katayama RC, Herbella FAM, Patti MG, Arasaki CH, Oliveira RO, de Grande AC. Sleeve gastrectomy technical parameters that may influence gastroesophageal reflux. AME Surgical Journal [Internet]. 2023 Oct [cited 2025 Jan 21];3:46–6.
Felinska E, Billeter A, Nickel F, Contin P, Berlth F, Chand B, et al. Do we understand the pathophysiology of GERD after sleeve gastrectomy? Annals of the New York Academy of Sciences. 2020 Sep 6;1482(1):26–35.
Serra FE, Cohen RV. Gastroesophageal reflux disease after sleeve gastrectomy. Digestive Medicine Research [Internet]. 2024 Mar 1;7:5–5.
Liu SY, Wong SK, Lam CC, Yung MY, Kong AP, Ng EK. Long-term Results on Weight Loss and Diabetes Remission after Laparoscopic Sleeve Gastrectomy for A Morbidly Obese Chinese Population. Obes Surg. 2015 Oct;25(10):1901-8. doi: 10.1007/s11695-015-1628-4. PMID: 25761944.
Fisher DP, Liu L, Arterburn D, Coleman KJ, Courcoulas A, Haneuse S, Johnson E, Li RA, Theis MK, Taylor B, Fischer H, Cooper J, Herrinton LJ. Remission and Relapse of Hypertension After Bariatric Surgery: A Retrospective Study on Long-Term Outcomes. Ann Surg Open. 2022 Apr 27;3(2):e158. doi: 10.1097/AS9.0000000000000158. PMID: 36936722; PMCID: PMC10013161.
Peromaa-Haavisto P, Luostarinen M, Juusela R, Tuomilehto H, Kössi J. Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years-A Prospective Multicenter Trial. Obes Surg. 2024 May;34(5):1544-1551. doi: 10.1007/s11695-024-07124-5. Epub 2024 Mar 8. PMID: 38457003; PMCID: PMC11031458.
Ghanem OM, Ghazi R, Abdul Razzak F, Bazerbachi F, Ravi K, Khaitan L, Kothari SN, Abu Dayyeh BK. Turnkey algorithmic approach for the evaluation of gastroesophageal reflux disease after bariatric surgery. Gastroenterol Rep (Oxf). 2023 Jun 9;11:goad028. doi: 10.1093/gastro/goad028. PMID: 37304555; PMCID: PMC10256627.
BRASIL. Ministério da Saúde; Instituto Brasileiro de Geografia e Estatística – IBGE. Pesquisa Nacional de Saúde 2019
FERRARI, G.; GIANNICHI, B.; RESENDE, B.; PAIVA, L.; ROCHA, R.; FALBEL, F.; RACHE, B.; ADAMI, F.; REZENDE, L. F. M. The economic burden of overweight and obesity in Brazil: perspectives for the Brazilian Unified Health System. Public Health, v. 207, p. 82–87, jun. 2022. DOI: 10.1016/j.puhe.2022.03.015
GIANNICHI, B.; NILSON, E.; FERRARI, G.; REZENDE, L. F. M. The projected economic burden of non-communicable diseases attributable to overweight in Brazil by 2030. Public Health, v. 230, p. 216–222, maio 2024. DOI: 10.1016/j.puhe.2024.02.029
FLORE, G.; PRETI, A.; CARTA, M. G.; DELEDDA, A.; FOSCI, M.; NARDI, A. E.; LOVISELLI, A.; VELLUZZI, F. Weight Maintenance after Dietary Weight Loss: Systematic Review and Meta-Analysis on the Effectiveness of Behavioural Intensive Intervention. Nutrients, v. 14, n. 6, p. 1259, 16 mar. 2022. DOI: 10.3390/nu14061259. Disponível em: https://www.mdpi.com/2072-6643/14/6/1259?utm_source=
MACHADO, P. P. P. et al. Understanding weight regain after a nutritional weight loss intervention: Systematic review and meta-analysis. Obesity Reviews, v. 23, n. 8, e13477, 2022. DOI: 10.1111/obr.13477.
UAB Reporter. Does your body really fight against weight loss? This scientist explains why the research says no. Birmingham, AL: UAB Reporter, 6 jun. 2024. Disponível em: https://www.uab.edu/reporter/research-innovation/does-your-body-really-fight-against-weight-loss-this-scientist-explains-why-the-research-says-no?utm_source=
STEPHENS, C. R. et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: STEP 1 trial extension. New England Journal of Medicine, v. 585, n. 4, p. 356-365, 2022. DOI: 10.1056/NEJMoa2205145.
ZHAO, H.; JIAO, L. Comparative analysis for the effect of Roux-en-Y gastric bypass vs sleeve gastrectomy in patients with morbid obesity: Evidence from 11 randomized clinical trials (meta-analysis). International Journal of Surgery, v. 72, p. 216-223, dez. 2019. DOI: 10.1016/j.ijsu.2019.11.013.
KWON, Yeongkeun et al. Comparative risk of anemia and related micronutrient deficiencies after Roux-en-Y gastric bypass and sleeve gastrectomy in patients with obesity: an updated meta-analysis of randomized controlled trials. Obesity Reviews, v. 23, n. 4, p. e13419, 2022. DOI: 10.1111/obr.13419. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35048495.
Kraljevic, Marko et al. Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity: The SM-BOSS Randomized Clinical Trial. JAMA Surgery, v. 160, n. 4, p. 369–377, 2025. DOI: 10.1001/jamasurg.2024.7052. Disponível em: https://pubmed.ncbi.nlm.nih.gov/39969869.
GOÍS, Raul Cézar Rosa Santos; GURGEL, Sylvia Pereira; PEREIRA, Milena Santos. Análise da morbimortalidade por complicações da cirurgia bariátrica no Brasil: uma revisão integrativa de literatura. Revista JRG de Estudos Acadêmicos, v. 8, n. 19, 2025. DOI: 10.55892/jrg.v8i19.2496. Disponível em: https://revistajrg.com/index.php/jrg/article/view/2496. Acesso em: 15 out. 2025.
SILVA, BGB. Eficácia da perda ponderal do bypass gástrico e da gastrectomia vertical. RBONE, 2021. Disponível em:
https://www.rbone.com.br/index.php/rbone/article/view/1880.
SCHIAVON, C. A.; BHATT, D.; IKEOKA, D.; SANTUCCI, E. V.; SANTOS, R. N.; DAMIANI, L. P.; OLIVEIRA, J. D.; MACHADO, R. H. V.; HALPERN, H.; MONTEIRO, F. L. J.; NOUJAIM, P. M.; COHEN, R. V.; DE SOUZA, M. G.; AMODEO, C.; BORTOLOTTO, L. A.; DRAGER, L. F. Three-Year Outcomes of Bariatric Surgery in Patients With Obesity and Hypertension: a Randomized Clinical Trial. Annals of Internal Medicine, v. 173, n. 9, p. 658-666, 2021. DOI: 10.7326/M19-3781.
VAN DIJK, M. K. et al. Comparative Safety of Sleeve Gastrectomy and Gastric Bypass. Obesity Surgery, v. 30, n. 7, p. 2750-2757, jul. 2020. DOI: 10.1007/s11695-020-04496-6.
ZNAMIROWSKI, P.; et al. Meta-analysis of Long-term De Novo Acid Reflux-Related Outcomes Following Sleeve Gastrectomy. Surgical Endoscopy, v. 38, n. 3, p. 1675-1687, 2024. DOI: 10.1007/s00464-023-10645-w.
PAVONE, G.; TARTAGLIA, N.; PORFIDO, A.; PANZERA, P.; PACILLI, M.; AMBROSI, A. The new onset of GERD after sleeve gastrectomy: A systematic review. Annals of Medicine and Surgery (Lond.), v. 77, p. 103584, apr. 2022. DOI: 10.1016/j.amsu.2022.103584.
DOWGIAŁŁO-GORNOWICZ, Natalia; LECH, Pawel. The real occurrence of gastroesophageal reflux disease after sleeve gastrectomy – a prospective pH-monitoring study. Videosurgery and other Miniinvasive Techniques, v. 19, n. 2, p. 205–210, 2024. DOI: 10.5114/wiitm.2024.138521. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC11223549/?utm_source=
PAVONE, Giovanna; TARTAGLIA, Nicola; PORFIDO, Alessandro; PANZERA, Piercamine; PACILLI, Mario; AMBROSI, Antonio. The new onset of GERD after sleeve gastrectomy: A systematic review. Annals of Medicine and Surgery, v. 77, p. 103584, 2022. DOI: 10.1016/j.amsu.2022.103584. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC9006745/
LIU, Genzheng; WANG, Pengpeng; RAN, Shuman; XUE, Xiaobin; MENG, Hua. Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy. Frontiers in Endocrinology, v. 15, p. 1463567, 2024. DOI: 10.3389/fendo.2024.1463567. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC11554513/
ALY, A. et al. Predictors of gastroesophageal reflux disease after sleeve gastrectomy: a multicenter prospective study. Surgery for Obesity and Related Diseases, Philadelphia, v. 15, n. 9, p. 1446–1452, 2019.
BAUMANN, T. et al. Influence of hiatal hernia and treatment on gastroesophageal reflux disease after sleeve gastrectomy. Obesity Surgery, v. 30, n. 7, p. 2563–2569, 2020. DOI: 10.1007/s11695-020-04491-6.
DESART, K. et al. Gastroesophageal reflux after laparoscopic sleeve gastrectomy: evaluation by pH impedance and high-resolution manometry. Surgical Endoscopy, New York, v. 35, n. 9, p. 4940–4950, 2021.
EL-HADI, M. et al. Gastroesophageal reflux disease following sleeve gastrectomy: mechanisms and management. Obesity Surgery, New York, v. 33, p. 1514–1521, 2023.
GILL, R. S. et al. Roux-en-Y gastric bypass as a revisional procedure following failed laparoscopic sleeve gastrectomy: a systematic review. Obesity Surgery, [s. l.], v. 30, n. 5, p. 1725–1733, 2020. DOI: https://doi.org/10.1007/s11695-019-04375-w.
HOMAN, J. et al. Long-term outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass for gastroesophageal reflux disease: 5-year follow-up. Surgical Endoscopy, v. 37, p. 6718–6726, 2023. DOI: 10.1007/s00464-023-10281-1.
KATKHODA, K. et al. Roux-en-Y gastric bypass as the procedure of choice for gastroesophageal reflux disease in the obese population. Surgical Endoscopy, New York, v. 34, n. 1, p. 405–411, 2020.
MAGNUSON, T. H. et al. Outcomes of revisional bariatric surgery after sleeve gastrectomy: an MBSAQIP analysis. Surgery for Obesity and Related Diseases, [s. l.], v. 17, n. 7, p. 1245–1252, 2021. DOI: https://doi.org/10.1016/j.soard.2021.02.024.
MAGRO, D. O. et al. Gastroesophageal reflux after bariatric surgery: a systematic review. Arquivos de Gastroenterologia, São Paulo, v. 57, n. 3, p. 231–236, 2020.
NEDELCU, M. et al. Esophageal reflux after sleeve gastrectomy: a prospective mechanistic study. Obesity Surgery, New York, v. 27, n. 3, p. 749–756, 2017.
OUALI, S. et al. Predictive factors of de novo gastroesophageal reflux disease after laparoscopic sleeve gastrectomy: results of a multicenter cohort. Obesity Surgery, New York, v. 32, n. 10, p. 3360–3367, 2022.
PEREZ, D. et al. Long-term outcomes after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for gastroesophageal reflux disease. Surgical Endoscopy, [s. l.], v. 38, p. 552–559, 2024. DOI: https://doi.org/10.1007/s00464-024-10653-x.
REYNOSO, H. V. et al. Outcomes of Roux-en-Y gastric bypass in patients with preexisting GERD: a long-term cohort study. Obesity Surgery, New York, v. 32, n. 5, p. 1249–1257, 2022.
RIERA, M. M. et al. Gastroesophageal reflux disease after bariatric surgery: a systematic review and meta-analysis. Journal of Gastrointestinal Surgery, v. 27, p. 2451–2462, 2023. DOI: 10.1007/s11605-023-05611-w.
RIERA, M. M. et al. Impacto das cirurgias bariátricas na doença do refluxo gastroesofágico: revisão sistemática. 2023. Disponível em: https://lume.ufrgs.br/handle/10183/268218. Acesso em: 12 out. 2025.
SALEH, A. et al. Impact of sleeve gastrectomy on gastroesophageal reflux disease. Obesity Surgery, New York, v. 27, n. 7, p. 1871–1879, 2017.
SANTONICOLA, A. et al. Pathophysiological mechanisms of gastroesophageal reflux after sleeve gastrectomy. Journal of Gastrointestinal Surgery, Philadelphia, v. 26, n. 4, p. 769–777, 2022.
SCHOMMER, K. et al. Predictors of persistent reflux after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass. Obesity Surgery, [s. l.], v. 33, p. 1156–1164, 2023. DOI: https://doi.org/10.1007/s11695-023-06628-2.
SHAHEEN, N. J. et al. ACG Clinical Guideline: diagnosis and management of Barrett’s esophagus. American Journal of Gastroenterology, New York, v. 116, p. 543–566, 2021.
SILVA, F. B. et al. Bypass gástrico em Y de Roux: implicações funcionais e metabólicas a longo prazo. Revista Brasileira de Cirurgia Bariátrica e Metabólica, São Paulo, v. 11, n. 2, p. 45–50, 2021.
STUART, M. et al. Outcomes after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for refractory gastroesophageal reflux disease. Surgical Obesity and Related Diseases, [s. l.], v. 16, n. 7, p. 899–905, 2020. DOI: https://doi.org/10.1016/j.soard.2020.02.027.
VILLAR, H. V. et al. Preoperative GERD as a risk factor for persistent symptoms after bariatric surgery: a comparative study. Obesity Surgery, v. 30, p. 453–460, 2020. DOI: 10.1007/s11695-019-04161-3.
YEUNG, K. T. D.; PENNA, M.; YEO, D. Meta-analysis of long-term de novo acid reflux-related outcomes following sleeve gastrectomy. Obesity Surgery, New York, v. 33, n. 8, p. 2547–2563, 2023.
