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Background <p>Gastroesophageal reflux disease (GERD) is a frequent concern following sleeve gastrectomy (SG), particularly in patients with hiatal hernia (HH). While crural repair is commonly employed, recurrence and persistent symptoms remain challenges. Ligamentum teres repair (LTR) has been proposed as a biologically reinforced alternative. This study compares the clinical outcomes of SG with LTR (SG-LTR) versus those with standard crural repair (SG-C) in patients with concurrent HH repair, focusing on GERD symptom resolution, weight loss, and safety.</p> Methods <p>This retrospective comparative study included 64 patients with concurrent HH undergoing laparoscopic SG between November 2022 and April 2023. Patients were divided into two groups: SG with crural repair (SG-C, <i>n</i> = 32) and SG with ligamentum teres repair (SG-LTR, <i>n</i> = 32). GERD symptoms were assessed using the GERD-Q at baseline, 3 months, and 6 months. Postoperative weight loss, body mass index (BMI), and resolution of comorbidities were also evaluated.</p> Results <p>Baseline characteristics were comparable between groups. Significant reductions in BMI and GERD-Q scores were observed in both groups over 6 months (<i>p</i> &lt; 0.001). SG-LTR achieved greater GERD-Q score improvement at 3 months (<i>p</i> = 0.019, 0.013) and 6 months (5.5 vs. 7.0, <i>p</i> = 0.019) and 6 months (4.0 vs. 6.0, <i>p</i> = 0.013). No intraoperative or postoperative complications were reported in either group. Operative time was slightly longer in SG-LTR but not statistically significant.</p> Conclusions <p>SG-LTR is a safe and effective alternative to SG-C in patients undergoing SG with incidental HH. It provides superior short-term GERD symptom control without compromising weight loss outcomes. However, these findings should be interpreted with caution, as non-randomized allocation and surgeon preference may have introduced bias, and the absence of objective GERD measures (such as pH-impedance testing or postoperative endoscopy) limits validation of symptom-based outcomes.</p>

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Ligamentum Teres Repair of Hiatal Hernias in Patients Undergoing Laparoscopic Sleeve Gastrectomy

  • 期刊论文

  • 发表日期：

    2025年12月20日

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  • Michael Shenouda,
  • Ahmed Salama,
  • George AbdelFady Nashed Aiad,
  • Mohamed Saber Mostafa,
  • Mohamed Nasr Shazly

摘要

Background

Gastroesophageal reflux disease (GERD) is a frequent concern following sleeve gastrectomy (SG), particularly in patients with hiatal hernia (HH). While crural repair is commonly employed, recurrence and persistent symptoms remain challenges. Ligamentum teres repair (LTR) has been proposed as a biologically reinforced alternative. This study compares the clinical outcomes of SG with LTR (SG-LTR) versus those with standard crural repair (SG-C) in patients with concurrent HH repair, focusing on GERD symptom resolution, weight loss, and safety.

Methods

This retrospective comparative study included 64 patients with concurrent HH undergoing laparoscopic SG between November 2022 and April 2023. Patients were divided into two groups: SG with crural repair (SG-C, n = 32) and SG with ligamentum teres repair (SG-LTR, n = 32). GERD symptoms were assessed using the GERD-Q at baseline, 3 months, and 6 months. Postoperative weight loss, body mass index (BMI), and resolution of comorbidities were also evaluated.

Results

Baseline characteristics were comparable between groups. Significant reductions in BMI and GERD-Q scores were observed in both groups over 6 months (p < 0.001). SG-LTR achieved greater GERD-Q score improvement at 3 months (p = 0.019, 0.013) and 6 months (5.5 vs. 7.0, p = 0.019) and 6 months (4.0 vs. 6.0, p = 0.013). No intraoperative or postoperative complications were reported in either group. Operative time was slightly longer in SG-LTR but not statistically significant.

Conclusions

SG-LTR is a safe and effective alternative to SG-C in patients undergoing SG with incidental HH. It provides superior short-term GERD symptom control without compromising weight loss outcomes. However, these findings should be interpreted with caution, as non-randomized allocation and surgeon preference may have introduced bias, and the absence of objective GERD measures (such as pH-impedance testing or postoperative endoscopy) limits validation of symptom-based outcomes.