Role of ligamentum teres cardiopexy during laparoscopic sleeve gastrectomy in patients with obesity with gastroesophageal reflux disease: a short-term retrospective study.

BACKGROUND

Most studies have described worsening or de novo development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG). Previous literature described a technique for managing GERD using the ligamentum teres hepatis as a sling around the esophagogastric junction, "ligamentum teres cardiopexy" (LTC). Recently, bariatric surgeons have proposed LTC for managing intrathoracic gastric migration and GERD after LSG. Few short-term studies with low numbers of patients have shown high rates of reflux resolution. This study was designed to retrospectively study the short-term outcome of LTC during LSG with hiatoplasty (HP) using objective assessment using manometry and endoscopy.

METHODS

Patients with morbid obesity with GERD who underwent LSG with suture HP, with or without LTC, and completed the follow-up requirements (at least 12 months of follow-up followed by endoscopy and manometry) were included. After a minimum of 1 year, the following data were collected and compared: percentage of excess weight loss (%EWL), GERD symptoms using the Gastroesophageal Reflux Disease Questionnaire (GERD-Q) score, and findings of postoperative investigations (endoscopy and manometry).

RESULTS

Overall, 32 patients were included in group A (LSG + HP). The mean %EWL was 65%. The mean GERD-Q score improved from 12.3 ± 2.9 to 9.8 ± 2.7. The mean lower esophageal sphincter (LES) pressure increased from 10.8 ± 3.2 to 13.7 ± 2.6 mm Hg. In addition, 29 patients were included in group B (LSG + HP + LTC). The mean %EWL was 63.2%. The mean GERD-Q score improved from 11.8 ± 3.1 to 8.3 ± 2.3. The mean LES pressure increased from 10.2 ± 3.4 to 13.1 ± 2.7 mm Hg. In both groups, endoscopy showed significantly less patients having hiatal hernia (HH) and esophagitis. All postoperative clinical data showed significant and highly significant improvement. When comparing both groups, the only significant difference was the GERD-Q score, in which a lower mean level was observed in group B.

CONCLUSION

Posterior suture HP during LSG with or without LTC in patients with GERD resulted in significant improvement of GERD symptoms, LES pressure values, esophagitis, and HH detection after 1 year. Adding LTC further improved the GERD symptoms.