Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy

Hawasli, Abdelkader; Foster, Robert E.; Lew, David; Peck, Laura R.

doi:10.1016/j.amjsurg.2020.12.036

Cited by 9 publications

(12 citation statements)

References 9 publications

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“…[ 18 ] LINX magnetic sphincter is another alternative but is expensive and not covered by most insurance companies. [ 19 ] Fundoplication is difficult to perform due to the lack of sufficient fundus post-SG. Laparoscopic ligament teres cardiopexy is a newer alternative with few reported complications.…”

Section: Discussionmentioning

confidence: 99%

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Post-laparoscopic sleeve gastrectomy, intrathoracic sleeve migration and its management: A case series and review of literature

Kalikar

Bhandarkar

Nasta

et al. 2023

Journal of Minimal Access Surgery

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De novo or persistent gastro-oesophageal reflux disease which may or may not be associated with injury of the oesophageal mucosa is now a known complication in post-sleeve gastrectomy patients. Repair of hiatal hernias to avoid such circumstances has been commonly performed, although recurrences may occur resulting in migration of gastric sleeve into the thorax, which is now a well-known complication. We report four cases of post-sleeve gastrectomy patients who presented with reflux symptoms, with their contrast-enhanced computed tomography abdomen showing intrathoracic sleeve migration and had hypotensive lower oesophageal sphincter with normal body motility on their oesophageal manometry. A laparoscopic revision Roux-en-Y gastric bypass surgery with hiatal hernia repair was performed for all four of them. No post-operative complications were seen at 1-year follow-up. Laparoscopic reduction of migrated sleeve with posterior cruroplasty and conversion to Roux-en-Y gastric bypass surgery can be safely performed for patients presenting with reflux symptoms in cases of intra-thoracic sleeve migration with good short-term outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Laparoscopic ligament teres cardiopexy is a newer alternative with few reported complications. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Post-laparoscopic sleeve gastrectomy, intrathoracic sleeve migration and its management: A case series and review of literature

Kalikar

Bhandarkar

Nasta

et al. 2023

Journal of Minimal Access Surgery

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“…In 1964 Rampal described his technique of ligamentum teres cardiopexy (LTC), whereby the ligamentum teres is mobilised off the liver and anterior abdominal wall and slung and secured around the gastro-esophageal junction [ 34 ]. The technique has re-surfaced for post-sleeve reflux as a RYGB alternative [ 35 , 36 ]. In this study cohort, phreno-esophageal ligament reconstruction by esophagopexy with a non-absorbable suture is analogous to the ligamentum teres approach and seems to deliver similar reflux control.…”

Section: Discussionmentioning

confidence: 99%

Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy

2022

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Background Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. Methods We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires. Results 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). Conclusion HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.

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“…Since only case reports and small cohort studies regarding cruroplasty/hiatal hernia repair alone and other investigational techniques alone exist, quality of evidence is low and the results of the current literature are not promising [20][21][22][23]. Even though, it seems, that reflux symptoms continue [24].…”

Section: Symptomatic Gerd After Sg and Adequate Weight Lossmentioning

confidence: 99%

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

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Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy

Cited by 9 publications

References 9 publications

Post-laparoscopic sleeve gastrectomy, intrathoracic sleeve migration and its management: A case series and review of literature

Post-laparoscopic sleeve gastrectomy, intrathoracic sleeve migration and its management: A case series and review of literature

Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

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