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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Article info
Publication history
Published online: August 08, 2019
Accepted:
July 20,
2019
Received:
June 14,
2019
Identification
Copyright
© 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
