Background

Vertical sleeve gastrectomy (VSG) is the most performed bariatric surgery in the United States, however, it is associated with an increased risk of gastroesophageal reflux disease (GERD) when compared to roux-en-y gastric bypass (RYGB). We previously demonstrated success with treating post-VSG patients who have medically refractory GERD with a ligamentum teres cardiopexy procedure (LT), demonstrating an 81% reduction or cessation in antacid medication requirements.

Methods

In this retrospective chart review, our institution's outcomes for patients who underwent RYGB conversion after VSG from 2018 to 2022 were compared to those who underwent LT after VSG. Pre-operative GERD disease burden and changes in PPI requirements were reviewed. Mann Whitney U tests and Fisher Exact tests were calculated using Microsoft Excel.

Results

This study identified 24 patients status-post VSG who underwent RYGB compared to 76 patients status-post VSG who underwent LT for GERD disease burden. There was no difference between the two groups for age, gender distribution and baseline median BMI. Both RYGB conversion (88%, 21 of 24) and LT patients (77%, 50 of 65) had improvement in reflux symptoms at 6 weeks post-op (p = 0.38). For RYGB patients, 29% had improvement in PPI usage at 1-year postoperative compared to 68% following LT (p = 0.004).

Conclusions

Ligamentum teres cardiopexy appears to provide comparable, if not better, improvement in self-reported GERD symptoms when compared to RYGB conversion in patients with intractable GERD following VSG at both the early and 1-year postoperative periods.