Lauren M Kastner, Dr, Stephen Leeds, Dr, Daniel Davis, Dr. Baylor University Medical Center Of Dallas
Background: Surgical management recommendations for intractable gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) remain controversial. This case series demonstrates our experience with treatment of post-operative intractable GERD using minimally invasive conversion of SG to Roux-en-Y gastric bypass (RYGB).
Patients and Methods: This is a retrospective review of a prospective data registry (MBSAQIP) from Jan 2016 through Sept 2017. Eleven patients, 10 female and 1 male, were evaluated. Of the 11 surgeries, 7 were laparoscopic, 3 assisted with Xi Da Vinci robot, and 1 assisted with Si Da Vinci Robot. All patients presented with intractable reflux on high dose PPI. Three had a history of aspiration pneumonia. The mean BMI at time of RYGB was 40.7 ± 11.1 kg/m2. Based on estimated time frames from medical records the mean interval time between sleeve and conversion to RYGB was 48.2 ± 17.3 months. Upper GI series on all eleven patients performed prior to RYGB showed significant reflux. pH studies were done on 4 patients with a mean DeMeester 43.3, pH < 4 mean time was 16%. High Resolution Manometry was performed on 3 patients with varied results of esophagogastric junction obstruction, spastic peristalsis, and Ineffective Motility Disorder with abnormal peristalsis.
Results: Mean operative time was 173.3 ± 62.6 minutes. There were no conversions to open surgery and no mortality. Mean hospital stay was 2.54 ± 1.21 days. Seven surgeries included a hiatal hernia repair
Five surgeries included laparoscopic fundectomy of the neofundus. All patients reported complete resolution of GERD symptoms. One developed empyema. Three developed stenosis of gastrojejunostomy. Initial mean BMI was 41.2 ± 11.1 kg/m2. After a mean follow up of 5.33 ± 2.89 months, mean change in BMI, % total weight loss, and %EBMIL was 8.64 ± 7.17 kg/m2, 13.73 ± 6.56%, 40.1 ± 14.88%, respectively. One was omitted due to pending results.
Conclusion: Several solutions exist for operative management of intractable GERD after SG including redo-sleeve gastrectomy, combined gastrectomy with fundoplication, conversion to gastric bypass or anti-reflux procedures such as LINX. Reports remain small in series and require further study to evaluate the consistency of results. We found minimally invasive conversion of SG to RYGB is a highly effective and safe option for treatment of intractable GERD.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88241
Program Number: P549
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster