The short-term effect of laparoscopic sleeve gastrectomy with his angle reconstruction (LSG-His) on gastroesophageal reflux disease

Abstract

Objective: While laparoscopic sleeve gastrectomy (LSG) is an established bariatric procedure for obesity, postoperative gastroesophageal reflux disease (GERD) remains a significant complication. This study evaluates the short-term efficacy of a novel technique combining LSG with acute angle of His reconstruction (LSG-His) versus conventional LSG. Methods: This is a single center retrospective observation cohort study. Among 83 patients undergoing bariatric surgery, 39 receiving conventional LSG and 44 undergoing LSG-His (with diaphragmatic fundopexy using 2-0 Prolene sutures) were analyzed. GERD symptoms were assessed using the Reflux Diagnostic Questionnaire (RD-Q) and GERD Questionnaire (GERD-Q) at baseline and at 3-, 6-, 12-, 24-month postoperatively. Weight loss outcomes included percentage of excess weight loss (%EWL) and total weight loss. Results: Postoperative follow-up showed a sustained reduction in GERD symptoms for the LSG-His group across all time points using both scoring systems (all p<0.001 vs LSG). The results demonstrated that, when assessed using the GERD-Q at the 24-month follow-up, the prevalence of GERD symptoms was 14% (95% CI: 6.3% - 25.7%) among LSG-His patients versus 46% (95% CI: 32.1% - 60.7%) among LSG patients (p<0.001). As evaluated via the RD-Q at the same 24-month follow-up, GERD symptom prevalence was 7% (95% CI: 2.3%- 17.9%) in the LSG-His group compared with 41% (95% CI: 27.3% - 56.3%) in the LSG group (p<0.001).%EWL was higher in the LSG-His group at 3 months (54.7% vs 46.5%, p=0.033), 6 months (73.8% vs 64%, p=0.047), 12 months (82.9% vs 72.2%, p=0.042) and 24 months (84.1% vs 75.4%, p=0.038) follow-up compared to LSG group. Conclusion: In this retrospective observational study, LSG-His was associated with lower rates of GERD symptoms and higher %EWL compared to standard LSG, but with comparable %TWL in 24 month outcomes. However, these preliminary results are limited to short-term follow-up, and long-term prospective studies with objective reflux assessment are warranted.