Laparoscopic sleeve gastrectomy with preservation of preexisting fundoplication wrap | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 41, Issue 2, April 2022 PDF (841.52 K) | ||||
| DOI: 10.4103/ejs.ejs_14_22 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
| Basem H. Abd-elAziz ELShayeb; Rabbah A. Khaled; Mohammed A. Hammoda | ||||
| Abstract | ||||
| Introduction Gastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders with significant prevalence in obese patients. Bariatric surgery for weight reduction is proven to improve the quality of life in obese GERD patients with gastric bypass as the first choice. Laparoscopic sleeve gastrectomy (LSG) is a safer and less complicated bariatric procedure. However, evidence exists that it induces GERD. There is not enough evidence on the outcome of LSG on patients with controlled GERD symptoms following antireflux surgery. Aim Our study aims at evaluating LSG as a surgical option for obese patients who have already undergone previous antireflux fundoplication. Patients and methods In all, six patients (three men, three women) with previous history of laparoscopic Nissen fundoplication for GERD underwent LSG for morbid obesity in this interventional clinical study. Patients included in the study had a BMI more than 40 kg/m or more than 35 kg/m with concomitant comorbidities. Patients with poor GERD-Health-Related Quality of Life score and patients dependent on proton-pump inhibitors were excluded. Freeing the stomach was done along its greater curve 4 cm from the pylorus until the left crus with preservation of any vascular adhesions around the old wrap. Standard sequential gastric stapling was done starting 4 cm from the pylorus and ending 1 cm lateral to the old wrap. Patients were followed up over a course of 6 months. Results Mean operative time was 40 + 5 min with no conversion to open surgery; no bleeding or leak was recorded. All patients were sent home on the second postoperative day, and there was no reoperation. At 6 months follow-up, the mean BMI dropped to 34 + 5 kg/m (<0.009), the mean total GERD-Health-Related Quality of Life score remained unchanged in four patients, and improved slightly in two patients. Conclusion LSG could present a safe, feasible, and effective bariatric alternative to gastric bypass in obese patients with preexisting fundoplication and controlled GERD symptoms. | ||||
| Keywords | ||||
| Bariatric; Fundoplication; gastrectomy; Gastroesophageal Reflux; Nissen-sleeve; Obesity | ||||
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