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Ligamentum Teres Cardiopexy Might Not Prevent Gastro-esophageal Reflux After Laparoscopic Sleeve Gastrectomy: Case Series

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Abstract

Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure in patients with obesity and gastroesophageal reflux (GERD), but in patients with preoperative hiatal hernia (HH) or GERD, who are unfit for RYGB, there are no clear guidelines. Ligamentum teres cardiopexy (LTC) has been proposed as an effective alternative. The purpose of this study was to analyze medium-term results of LTC procedure associated with laparoscopic sleeve gastrectomy (LSG) in patients with GERD or HH, according to the absence of pathologic acid reflux in esophageal 24 h pH monitoring test, symptom release, or PPI reduction. Five patients underwent LSG-LTC between March 2018 and October 2019. In one patient, the effectiveness of LTC as an anti-reflux procedure could not be assessed because of conversion to RYGB was required. After a follow-up period of 30 [24–42] months and excessive BMI loss of 62.74 ± 18.18%, GERD recurrence was observed in 75% of patients. The study was discontinued due to unsatisfactory preliminary results with LTC. Our results suggest that LTC might not prevent GERD after LSG in patients with preoperative GERD or HH.

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Fig. 1

Data Availability

Data can not be published as these data contains private personal  information.

Abbreviations

ACG :

Atrophic chronic gastritis

EBMIL :

Excess body mass index loss

EGJ :

Esophagogastric junction

EGJOO :

Esophagogastric junction outflow obstruction

GERD :

Gastro-esophageal reflux disease

HH :

Hiatal hernia

IM :

Intestinal metaplasia

LSG :

Laparoscopic sleeve gastrectomy

LTC :

Ligamentum teres cardiopexy

RYGP :

Roux-en-Y gastric bypass

PPI :

Proton pump inhibitors

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Authors and Affiliations

  1. General and Digestive Surgery, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, Spain

    Javier Martínez Caballero & Eduardo Ferrero Herrero

  2. Bariatric, Metabolic and Upper-GI surgery department, 12th October University Hospital, Av. de Córdoba, s/n, 28041, Madrid, España

    Felipe de la Cruz Vigo, Pilar Gómez Rodríguez, Diego Hernández García-Gallardo, Ana Isabel Pérez Zapata, Cristina Alegre Torrado & Elías Rodríguez Cuéllar

Authors
  1. Javier Martínez Caballero
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  2. Felipe de la Cruz Vigo
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  3. Pilar Gómez Rodríguez
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  4. Diego Hernández García-Gallardo
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  5. Ana Isabel Pérez Zapata
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  6. Cristina Alegre Torrado
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  7. Eduardo Ferrero Herrero
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  8. Elías Rodríguez Cuéllar
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Javier Martínez Caballero. Patient selection and surgery were performed by F. de la Cruz Vigo, E. Rodríguez Cuéllar, and P. Gómez Rodríguez. Patient follow-up was performed by E. Rodríguez Cuéllar and P. Gómez Rodríguez, and complementary tests were performed by D. Hernández García-Gallardo, A. Pérez Zapata, and C. Alegre Torrado. The first draft of the manuscript was written by Javier Martínez Caballero, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Javier Martínez Caballero.

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Key Points

• Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure in patients with obesity and gastro-esophageal reflux (GERD).

• In patients with preoperative hiatal hernia (HH) or GERD who are unfit for RYGB, due to gastric premalignant conditions, there are no clear guidelines. .

• In this context, ligamentum teres cardiopexy (LTC) has been proposed as an effective alternative to the RYBP with remnant resection.

• We aim to analyze medium-term results of LTC procedure associated with LSG in patients with GERD or HH.

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Martínez Caballero, J., de la Cruz Vigo, F., Gómez Rodríguez, P. et al. Ligamentum Teres Cardiopexy Might Not Prevent Gastro-esophageal Reflux After Laparoscopic Sleeve Gastrectomy: Case Series. OBES SURG 33, 965–968 (2023). https://doi.org/10.1007/s11695-022-06413-1

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  • DOI: https://doi.org/10.1007/s11695-022-06413-1

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