Revision of Sleeve Gastrectomy with Hiatal Repair with Gastropexy for Gastroesophageal Reflux Disease.

ABSTRACT

BACKGROUND: Gastroesophageal reflux disease (GERD) is the major drawback of laparoscopic sleeve gastrectomy (LSG). Conversion to Roux-en-Y bypass is recommended but might not be suitable for all patients. METHODS: We retrospectively reviewed the data of patients who underwent laparoscopic hiatal repair and gastropexy for intractable GERD after LSG between 2015 and 2017. Data on upper gastrointestinal (GI) study findings and proton pump inhibitor (PPI) use was collected. The GERD-health-related quality of life (GERD-HRQL) questionnaire assessed patient symptoms. Perioperative outcomes, GERD symptoms, and medication details were analyzed. RESULTS: Twenty-eight patients were included. Mean interval from the initial LSG to revision surgery was 40.8 months (range, 6-108). Mean body mass index before LSG was 34 kg/m2, whereas that before revision surgery was 25.7 kg/m2. Mean revision surgery time was 126 min, whereas the mean length of stay was 3.6 days. No major surgical complication occurred. The mean GERD-HRQL score before revision surgery was 24.3 and decreased to 12.3 at 1 month after surgery. Mean GERD-HRQL scores at 6, 12, and 24 months after revision surgery were 16.8, 17.4, and 18.9, respectively. All patients required daily proton pump inhibitor pre-operatively; only 26% could discontinue them postoperatively. Of the 28 patients, 14 (50.0%) were satisfied with the surgery, 8 (28.6%) had a neutral attitude, and 6 (21.4%) were dissatisfied. Three (11.1%) patients agreed to undergo Roux-en-Y gastric bypass. CONCLUSION: Hiatal repair with gastropexy is an acceptable treatment option for GERD after LSG but not very effective because of partial remission of symptoms.