Role of Ligamentum Teres Cardiopexy During Laparoscopic Sleeve Gastrectomy in Obese Patients With Gastro-esophageal Reflux Disease - A Short-Term Retrospective Study
Abstract
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 proposed LTC for managing intrathoracic gastric migration (ITGM) 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 study retrospectively the short-term outcome of LTC during LSG with hiatoplasty (HP) with objective assessment using manometry and endoscopy.
METHODS
Morbidly obese GERD patients who underwent LSG with suture HP, with or without LTC and completed the follow-up (FU) requirements (at least 12 months FU followed by endoscopy and manometry) were included. After minimum one year, the following data were collected and compared: Percentage of excess weight loss (%EWL), GERD symptoms using GERD-Q score, and findings of postoperative investigations (endoscopy and manometry).
RESULTS
Thirty-two patients were included in Group-A (LSG+HP); mean %EWL was 65%. Mean GERD-Q score improved from 12.3±2.9 to 9.8±2.7. Mean lower esophageal sphincter (LES) pressure rose from 10.8±3.2 to 13.7±2.6mmHg. 29 patients were included in Group-B (LSG+HP+LTC); mean %EWL was 63.2%. Mean GERD-Q score improved from 11.8±3.1 to 8.3±2.3. Mean…
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