Laparoscopic partial sleeve gastrectomy with fundoplication for gastroesophageal reflux and delayed gastric emptying.

Abstract

A difficult management problem for the upper gastrointestinal surgeon exists when a patient presents with symptomatic and refractory severe delayed gastric emptying. Surgical treatment is further complicated by coexisting gastro-oesophageal reflux. No universal surgical strategy exists for this problem. A novel surgical strategy combines partial sleeve gastrectomy (SG) and hiatus hernia (HH) repair with fundoplication. A review of treating four such patients is described with objective outcome data. Overall, solid gastric emptying improved in all, from median 350 (163-488) min pre-operatively to 108 (84-135) at 10 months (3-24) post-operatively, corresponding to 67% improvement. Primary symptoms resolved in all; however, one patient had recurrent symptoms. GERD-HRQL also improved in all, from median 23 (3-25) to 4 (0-8) at 21 months (6-30, 83% improvement). Gas bloat improved in three. All had post-operative gastroscopies showing intact repair and absent oesophagitis, with no patient requiring post-operative PPI. Patient weight reduced by median 11% (7-20) post-operatively. There was no significant peri-operative morbidity. With careful patient selection and work-up, SG and HH repair with fundoplication may improve quality of life by coupling adequate reflux control with improved gastric emptying.