Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

Abstract

Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish le-

Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

“…Recently, we reported a case of a primary SG with GERD. This approach controlled both diseases, in a 3-years follow-up, avoiding exclusions and keeping duodenum accessibility, which could solve the issues related to RYGB [23]. These same principles were replicated in the revisional cases of this study, with the addition of either selective or truncal vagotomies, for the reasons already mentioned.…”

“…Recently we published a paper showing the association of SG with antrojejunal anastomosis, keeping the pylorus intact, in an obese patient with GERD. The with a 3-year follow-up showed good results in terms of weight loss and GERD control, surpassing the issues related to gastrointestinal diversions [23]. These principles could be applied as a revisional option, after a failed SG.…”

“…The current article reports two cases of obese patients who regained weight after SG and developed GERD ("De Novo GERD"). They had dilated sleeve tubes and were scheduled to a re-sleeve, associated with RYGB in the antrum [23]. The main intention in this proposal was to keep the rational that lead to the indication of primary SGs.…”