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Sleeve gastrectomy in patients with previous antireflux surgery. Preliminary results of the “no-touch to posterior wrap” technique

Published:August 08, 2019DOI:https://doi.org/10.1016/j.soard.2019.07.021

      Highlights

      • Best bariatric option in patients with previous anti-reflux surgery is unknown.
      • Roux-en-Y gastric by-pass is shown to be feasible with extreme morbidity.
      • In this context, we provide data that sleeve gastrectomy is safe and efficient.
      • Anterior unfolding of a functioning fundoplication preserves anti-reflux mechanism.

      Abstract

      Background

      Reported morbidity of Roux-en-Y gastric bypass in patients with previous antireflux surgery warrants caution, and data on sleeve gastrectomy (SG) are unexpectedly scarce.

      Objectives

      To evaluate the safety and efficiency of SG in patients who previously underwent an antireflux procedure. A new technique to preserve intact fundoplication is described.

      Setting

      Private practice, bariatric center of excellence, Turkey.

      Methods

      The following data were retrieved from our prospective data base: (1) details of previous repair; (2) clinical/endoscopic reflux status, body mass index (kg/m2), and presence of metabolic syndrome (MetS) and type 2 diabetes (T2D) before SG; (3) duration of SG, length of stay, complications; and (4) percent excess weight loss, MetS/T2D resolution, and reflux status at follow-up.

      Results

      Fifteen consecutive SGs were performed without conversion or major complications. The first case is excluded from the analysis because complete wrap unfolding was abandoned in favor of the described technique. Among 14, 10 had MetS, 4 had T2D, and 1 had a proven reflux recurrence before SG. Mean operating time was 118.5 minutes. All were discharged on the third postoperative day. Apart from 1 functional stenosis, no complications occurred. At 12 months, percent excess weight loss rate was 82.2, MetS resolved in 9 of 10, and T2D was in complete (n = 2) or partial remission (n = 1). No de novo reflux became evident, and absence of reflux was proved by pHmeter in 3.

      Conclusions

      SG is feasible in patients who previously had antireflux repair with negligible morbidity and percent excess weight loss rates similar to that with regular sleeves. Results in reflux control needs further confirmation.

      Key words

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