Gastropexy predicts lower use of acid-reducing medication after laparoscopic sleeve gastrectomy. A prospective cohort study

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) may induce gastro-oesophageal reflux disease and surgical techniques should be sought to reduce reflux after LSG. Gastropexy of the sleeve gastrectomy pouch to prevent kinks, torsion and intrathoracic sleeve migration was added to our standard LSG in 2012, and the aim of this study was to evaluate if adding gastropexy has influenced the occurrence of gastrooesophageal reflux symptoms (GORS) after LSG. Methods: In this prospective two-cohort study, the group with LSG and gastropexy (G) was compared with a historical cohort who did not have gastropexy (NG). The use of acid-reducing medication (ARM) was used as a proxy measure of GORS. Gastropexy was performed by suturing the gastrocolic ligament (including the gastroepiploic arcade) to the staple line from the cardia to well below the incisura angularis. Non-resorbable sutures were used. Multiple logistic regression analysis was used to study differences in the use of ARM between the NG and G group two years after surgery. Results: Patient characteristics as age, gender and BMI at baseline, and excess body mass index loss (EBMIL) and smoking at two years were similar between the NG group (n = 216) and G group (n = 116). The follow-up rate was 86.4% for the NG group and 85.3% for the G group. Adding gastropexy did not increase the morbidity rate. In the NG group, the number of patients using ARM was 21 (9.7%) preoperatively and 66 (30.6%) two years after surgery. In the G group, the number using ARM was 11 (10.4%) preoperatively and 18 (14.2%) two years after surgery. The adjusted odds ratio for postoperative GORS in group G compared to group NG was 0.32 (95% CI: 0.16–0.64, p < 0.001). Conclusion: Gastropexy may prevent postoperative reflux symptoms after LSG. We recommend to evaluate gastropexy in a randomized controlled trial.