Accentuation of the Angle of His is Associated with Reduced GERD without Affecting Weight Loss up to 12 Months after Sleeve Gastrectomy (LSG) : A Retrospective Single-Center Cohort Study.

BACKGROUND: Although laparoscopic sleeve gastrectomy (LSG) is effective for weight loss, postoperative gastroesophageal reflux disease (GERD) remains a significant concern. OBJECTIVE: To evaluate whether accentuation of the Angle of His influences postoperative GERD, weight loss, complications, and comorbidity outcomes. METHODS: A retrospective single-center analysis was conducted on 192 patients who underwent LSG between 2018 and 2021. Patients were grouped into standard LSG and LSG with accentuation of the Angle of His. Outcomes included GERD incidence (GERD-Q), weight loss, and comorbidity resolution at 1, 3, 6, and 12 months. Statistical analyses included independent t-tests, chi-square tests, and Fisher’s exact test where appropriate (p < 0.05 considered statistically significant). Ethical approval was obtained, and all procedures were conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all patients. RESULTS: Accentuation of the Angle of His was associated with lower incidence of postoperative GERD (12-month incidence: 38.2% vs. 2.9%; p < 0.001). Weight loss was unaffected by accentuation (p > 0.05 at all-time points), although males achieved greater reductions than females (p < 0.001). Leakage occurred in 2 patients without accentuation (2.2%) and none with accentuation. In patients with preoperative hiatal hernia, no reflux was observed in the accentuation group compared with 38.5% without accentuation (p < 0.001), however, this subgroup analysis is limited by small sample size and should be interpreted cautiously. CONCLUSIONS: Accentuation of the Angle of His during LSG was associated with a marked reduction in postoperative GERD without compromising short-term weight loss outcomes. These findings are hypothesis-generating and warrant confirmation in prospective or randomized studies.