Introduction:

Over the past years, laparoscopic greater curvature plication (LGCP) is gaining interest as an alternative to other bariatric procedures because of the low postoperative complication rates, the advantage of being less invasive, and the favorable obesity-related short-term outcomes.^1,2 Available data indicate an incidence of de novo gastroesophageal reflux disease (GERD) of up to 39%.³ However, the effect of LGCP on pre-existing GERD or on the development of de novo GERD remains unclear and further investigation is highly desirable.³ The purpose of this video was to demonstrate the management of severe GERD after LGCP in a 28-year-old female patient who underwent LGCP for morbid obesity 6 years ago (initial weight 129 kg; body mass index [BMI] 53.6 kg/m²; current weight 97 kg; BMI 40.3 kg/m²). The patient was referred to our institution for worsening dysphagia and de novo GERD.

Materials and Methods:

We provide an intraoperative video to demonstrate the feasibility of a patient-tailored laparoscopic redo procedure to treat both GERD and recurrence of morbid obesity. The procedure started with the section of mild adhesions along the “neo”-greater curvature and at the angle of His. A small axial hernia was detected. The gastric plication was completely reversed, and the distal esophagus was mobilized. A dorsal hiatoplasty was carried out and a gastric pouch was formed using 45 and 60 mm staple cartridges. The remnant fundus and a part of the corpus had to be resected because of poor perfusion after creating the gastric pouch. The limited perfusion was attributed to the index procedure, during which the short gastric vessels were dissected to mobilize the greater curvature. A 50 cm biliopancreatic limb length was formed and a gastrojejunostomy was performed in a linear manner using a 30 mm staple cartridge and a 3-0 barbed absorbable running suture. The alimentary limb length was measured at 160 cm and a jejunojejunostomy was performed in a similar manner. Finally, the biliopancreatic limb was transected.

Results:

The operative time was 170 minutes. The postoperative course was uneventful, and the patient was discharged on postoperative day 4. At the 3, 6, and 12-month follow-up, the patient was asymptomatic and had lost 25% of total weight (BMI = 29.9 kg/m²) and antireflux medication was discontinued.

Conclusions:

In contrast to sleeve gastrectomy, where Roux-en-Y gastric bypass (RYGB) is considered the “gold standard” in the therapy of de novo GERD, there are no clearly defined treatment options in case of LGCP.^4

–7 After gastroplication, intraluminal pressure increases similar to gastric sleeve resection because of the significantly reduced volume. De novo GERD after LGCP might result from both a compromised lower esophageal sphincter (LES) and an elevated intraluminal pressure exceeding the LES closing pressure. LGCP is still a rare procedure, but the number is increasing. Consequently, surgeons will increasingly be confronted with procedure-related complications, such as de novo GERD. The laparoscopic conversion to an RYGB appears to be safe and effective to relieve GERD symptoms by converting the intraluminal high-pressure system to a low-pressure system.

No competing financial interests exist.

Runtime of video: 9 mins 58 secs

Authors' Contributions: S.H., G.G., A.E.S., H.M., A.A.-A., P.R.S., D.B., and M.G. have contributed equally to this study.

Informed Consent: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Funding Information:

No funding was received for this article.

Search results

Laparoscopic Roux-en-Y Gastric Bypass and Fundus Resection for the Treatment of Severe Gastroesophageal Reflux After Laparoscopic Greater Curvature Plication