Innovative surgical approach lowers GERD symptoms after sleeve gastrectomy :- Medznat

Laparoscopic sleeve gastrectomy (LSG) is widely used for obesity management, yet it can worsen gastroesophageal reflux disease (GERD) symptoms in patients with underlying hiatal laxity.

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Key take away

Adding posterior cruroplasty to sleeve gastrectomy significantly improves short-term GERD symptom control compared to standard laparoscopic sleeve gastrectomy in patients with intraoperative hiatal laxity.

Background

Laparoscopic sleeve gastrectomy (LSG) is widely used for obesity management, yet it can worsen gastroesophageal reflux disease (GERD) symptoms in patients with underlying hiatal laxity. Integrating cruroplasty into the procedure is increasingly explored as a strategy to stabilize the gastroesophageal junction and mitigate postoperative reflux.

This randomized controlled trial examined whether adding posterior cruroplasty to LSG (Cr-LSG) improved postoperative GERD symptom control in people with intraoperative hiatal laxity.

Method

Overall, 100 obese people undergoing LSG were randomly allocated to receive either standard LSG or Cr-LSG. Those with large hiatal hernias were excluded. GERD symptoms were measured at baseline, 3 months, and 6 months with the help of a validated GERD–health related quality of life questionnaire (GERD-HRQL). Body mass index (BMI) changes were recorded at each time point. Mixed-design ANOVA was used to evaluate within- and between-group differences. Follow-up was completed by 95 participants.

Result

Both groups experienced remarkable reductions in BMI across the study period, with no pivotal differences between treatment arms. GERD symptoms improved postoperatively in both cohorts; however, the Cr-LSG group exhibited substantially lower GERD-HRQL scores at 3 and 6 months (p < 0.05), indicating superior reflux control.

Conclusion

The addition of Cr-LSG enhanced short-term reflux symptom control in people with intraoperative hiatal laxity while achieving comparable weight loss outcomes. However, the reliance on subjective symptom assessments and limited follow-up duration suggests the need for longer-term, objectively measured studies to validate sustained clinical benefits.