Gastroesophageal reflux disease symptoms after sleeve gastrectomy with anterior hemifundoplication: a pilot study

BackgroundGastroesophageal reflux disease (GORD) is a significant problem after laparoscopic sleeve gastrectomy (SG). This study aimed to assess the long-term effect of SG with an anterior fundoplication on GORD symptoms.MethodsA single-centre cohort study of all patients who underwent SG with anterior hemifundoplication (SGAF), with a 2:1 SG only comparison group. GORD symptoms were assessed using a structured symptom questionnaire.ResultsSGAF was performed in 36 patients between 2010 and 2015; 26 patients were available for follow-up and 17 of these were followed up for more than 6 years. The comparison group included 53 consecutive contactable patients who underwent SG without fundoplication during the same period. The two patient groups were similar with regard to pre-operative factors, weight loss, and weight regain. After 6 years, 12 (71%) of SGAF patients reported no GORD symptoms compared to 9 (17%) of SG patients. GORD symptoms were no worse in 21 (81%) following SGAF, whereas GORD symptoms worsened (worse or new symptoms) in 22 (58.5%) of patients after SG. PPI use was similar in both groups. Eight of 26 (31%) SGAF patients had some degree of fundoplication dilatation and underwent conversion to SG or RYGB.ConclusionsSGAF provided superior control of symptomatic GORD than SG in this study. Fundoplication dilatation treated by conversion to standard SG was not uncommon and was the reason for suspending this series. Reducing intragastric pressure and reducing fundoplication volume may alleviate this problem, which may also be overestimated in this pilot study.