Reinforcement of the esophageal hiatus using ligamentum teres during sleeve gastrectomy concerning gastroesophageal reflux disease

Background
Gastroesophageal reflux disease (GERD) represents a disorder of the superior gastrointestinal tract that is defined by heartburn and regurgitation, which develops when reflux of the stomach contents causes troublesome symptoms and/or complications, according to the Evidence-Based Consensus of the Montreal Definition and Classification of Gastroesophageal Reflux Disease. Apart from heartburn and regurgitation, symptoms include dysphagia, chest pain, shortness of breath, cough, and hoarseness. GERD can be seen as one of sleeve gastrectomy’s (SG) most important side effects and is still controversially discussed in the literature. Severe reflux does not only impact a patient’s quality of life and forces them to permanently depend on proton pump inhibitors, it can actually lead to esophagitis, which can in turn cause Barrett’s esophagus – a potential factor for the development of esophageal carcinoma.
Patients and methods
This is a prospective randomized study conducted on patients undergoing laparoscopic SG, and patients are randomly fit into one of the two groups A and B. The study was conducted on an estimated sample size of 60 patients (30 patients for each group). This study was conducted at the Bariatric Surgery Unit at Ain Shams University Hospitals starting from October 2019 to January 2021. Approval of the Ethics Committee and written informed consent from all participants was obtained.
Results
Our study results showed that group A which underwent SG only with no symptoms or signs of GERD preoperatively, the percentage of patients who developed GERD postoperatively through the 1st, 3rd, 6th, and 12th months of follow-up was 6.7, 16.7, 20, and 23.3%, respectively, and the percentage endoscopically for the development of GERD was 26.7 and 30% during the 6 and 12 months of follow-up. Also, our study results showed that in group B which underwent SG with ligamentum teres reinforcement of the hiatus, the percentage of patients who developed GERD postoperatively through the 1st, 3rd, 6th, and 12 months was 0, 0, 3.3, and 3.3%, respectively, and endoscopically was 3.3 and 6.7% during the 6 and 12 months of follow-up.
Conclusion
According to our study results, ligamentum teres reinforcement of the esophageal hiatus during SG showed a significant decrease in the development of GERD either symptomatically or endoscopically and is recommended as a preventive measure for the development of reflux postoperatively if done concomitantly with SG, which showed favorable results when compared with the ordinary technique; however, further, larger study groups and a long-term follow-up were needed.