Antireflux sleeve gastroplasty: description of a novel technique.

BACKGROUND

Laparoscopic sleeve gastrectomy for morbid obesity is associated with a high incidence of postoperative permanent heartburn as a result of gastroesophageal reflux. In order to avoid this complication, the authors developed a new technique, combining the creation of a very long and narrow vertical gastroplasty with an antireflux procedure.

METHOD: The new operation was performed in 3 patients with BMI 40, 46 and 50 (1 male, 2 females). All the procedures were conducted laparoscopically using 6 trocars. The greater curvature of the stomach was mobilized in the antral region. A primary hole in both walls of the stomach was made in the antrum 5-7 cm proximal to the pylorus. Starting from this hole, the stomach was stapled and divided along a 33-Fr bougie to the angle of His, creating a long (15-20 cm), narrow tube. The divided fundus was then passed behind the mobilized abdominal part of the esophagus and a 360 degrees wrap was made (as in a Nissen procedure).

RESULTS

None of the 3 patients developed complications. Excess BMI loss at 5 to 7 months has been good. No signs of esophagitis have been revealed during postoperative upper GI endoscopy.

CONCLUSION

This operation is technically simple. Preliminary early postoperative results regarding its antireflux and weight-loss effects are encouraging.