Treating Severe GERD and Obesity with a Sleeve Gastrectomy with Cardioplication and a Transit Bipartition

Abstract

Introduction

Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD). The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30. Although still controversial in the literature, there are several studies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The current video shows the technique of a SG with cardioplication associated with transit bipartition (TB) for the treatment of an obese patient with severe GERD.

Case Report and Management

A 46-year-old male presented with obesity and GERD symptoms for several years. His BMI was 37.8 kg/m2 with mainly central obesity and several obesity-related comorbidities, including hypertension, dyslipidemia, severe insulin resistance, and obstructive sleep apnea. After a diagnostic evaluation, the patient was submitted to a sleeve gastrectomy with a transit bipartition. He presented satisfactory weight loss, reaching a BMI of 26 and remission of all comorbidities and complete remission of GERD symptoms. The current follow-up period is 2.5 years and the patient did not present any weight regain or return of the GERD symptoms.

Conclusion

We presented a surgical alternative that is effective in both weight loss and remission of GERD. SG + TB is a potent intervention for metabolic syndrome and obesity. Furthermore, this alternative is capable of treating both obesity and GERD, in a simple way, avoiding mechanical restriction and the significant malabsorption related to excluded segments.

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References

  1. 1.

    Jacobson BC, Somers SC, Fuchs CS, et al. Body-mass index and symptoms of gastroesophageal reflux in women. N Engl J Med. 2006;354(22):2340–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. 2.

    El-Serag HB, Graham DY, Satia JA, et al. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100(6):1243–50.

    Article  PubMed  Google Scholar 

  3. 3.

    Kouklakis G, Moschos J, Kountouras J, et al. Relationship between obesity and gastroesophageal reflux disease as recorded by 3-hour esophageal pH monitoring. Rom J Gastroenterol. 2005;14(2):117–21.

    PubMed  Google Scholar 

  4. 4.

    Wu JC, Mui LM, Cheung CM, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology. 2007;132(3):883–9.

    Article  PubMed  Google Scholar 

  5. 5.

    Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg. 2004;14(7):959–66.

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005;15(9):1225–32.

    Article  PubMed  Google Scholar 

  7. 7.

    Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter a er sleeve gastrectomy in obese patients. Obes Surg. 2010;20(3):357–62.

    Article  PubMed  Google Scholar 

  8. 8.

    Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy—volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.

    Article  PubMed  Google Scholar 

  9. 9.

    Santoro S. Technical aspects in sleeve gastrectomies. Obes Surg. 2007;17(11):1534–5.

    Article  PubMed  Google Scholar 

  10. 10.

    Santoro S, Lacombe A, Aquino CGA, et al. Sleeve gastrectomy with anti-reflux procedures. Einstein. 2014;12(3):287–94.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Santoro S, Castro LC, Velhote MC, et al. Sleeve gastrectomy with transit bipartition: a potent intervention for metabolic syndrome and obesity. Ann Surg. 2012 Jul;256(1):104–10.

    Article  PubMed  Google Scholar 

  12. 12.

    Santoro S. From bariatric to pure metabolic surgery: new concepts on the rise. Ann Surg. 2015;262:79–80.

    Article  Google Scholar 

  13. 13.

    Azevedo FR, Santoro S, Correa-Giannella ML, et al. A prospective randomized controlled trial of the metabolic effects of sleeve gastrectomy with transit bipartition. Obes Surg. 2018 Oct;28(10):3012–9.

    Article  PubMed  Google Scholar 

  14. 14.

    Yormaz S, Yılmaz H, Ece I, et al. Laparoscopic Ileal interposition with diverted sleeve gastrectomy versus laparoscopic transit bipartition with sleeve gastrectomy for better glycemic outcomes in T2DM patients. Obes Surg. 2018 Jan;28(1):77–86.

    Article  PubMed  Google Scholar 

  15. 15.

    Bilecik T. Metabolic effects of sleeve gastrectomy with transit bipartition in obese females with type 2 diabetes mellitus: results after 1-year follow-up. Obes Surg. 2018 Nov 17;

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Authors SS, CGA, and FCM were responsible for conception and design, and also performed drafting and critical revision of the manuscript.

All authors contributed to and have approved the final manuscript. All authors take public responsibility for its content.

Corresponding author

Correspondence to Filippe Camarotto Mota.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Santoro, S., Mota, F.C. & Aquino, C.G. Treating Severe GERD and Obesity with a Sleeve Gastrectomy with Cardioplication and a Transit Bipartition. OBES SURG 29, 1439–1441 (2019). https://doi.org/10.1007/s11695-019-03752-4

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Keywords

  • Morbidity obesity
  • GERD
  • Bariatric surgery
  • Sleeve gastrectomy
  • Transit bipartition