Ricardo Nassar, MD, Surgeon, Gastrointestinal Surgery, Juan David Hernandez, MD, Surgeon, FACS, Felipe Giron, MD, MSc, Alberto Ricaurte, MD, Surgeon, Juan David Linares, MD, Surgeon, Natan Zundel, MD, Surgeon. Fundación Santa fe de Bogota
Introduction: Obesity has become a worldwide public health problem, affecting rich and poor countries alike. Bariatric surgery is still the best treatment to achieve significant and long lasting weight loss and control of comorbidities. Laparoscopic Sleeve Gastrectomy (LSG) has become the most frequently practiced operation, even more than laparoscopic Roux-en –Y gastric bypass. GERD is a common disease among obese patients with prevalence between 39% and 61% before surgery. There is controversy in choosing the best approach to manage GERD whether if it was present before, worsens, or appears de novo in relation with bariatric surgery. It has been suggested that GERD can be either treated or prevented using a technique inspired in Hill’s posterior gastropexy. We present our experience with this procedure.
Objective: To describe both surgical technique and results of a treatment for GERD based in Hill technique, which can be carried out simultaneously in patients undergoing LSG, or in patients who already have been operated in the past.
Methods: Retrospective observational study based on a prospectively recorded database of patients with GERD who underwent a “Hill modified technique” either concomitantly with a LSG or who presented with GERD after a previous LSG. Patients were followed-up for at least 3 years since 2014, both for obesity control and GERD, this last based on the presence or absence of symptoms. All patients treated were included, and all of them had preoperative studies showing pathologic reflux. Surgical technique is based in obtaining an intra-abdominal esophageal length of minimum 3 cm, posterior closure of the hiatus, and posterior fixation of gastroesophageal junction to the crus, with at least two non-absorbable stitches.
Results: A total of 18 consecutive patients underwent closure of the hiatus and posterior gastropexy. 5 patients had the procedure alone to treat post-LSG symptomatic GERD. 13 had the procedure simultaneously with LSG. There were no complications associated to the procedure and none of the patients needed reintervention or medication out of the standard protocol. Postoperative controls were at 1, 3, 6, 12, 18, 24 and 36 months. All patients have shown satisfactory results in the control and management of both obesity and GERD, remaining asymptomatic during the study period.
Conclusion: “Hill modified technique” has shown adequate control of GERD symptoms in patients with LSG with no complications. Longer series and comparison with other strategies will allow to determine protocols for GERD treatment in patients undergoing bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95606
Program Number: P149
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster