Combined Partial Toupet Fundoplication With Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity and Symptomatic GERD: Preliminary Results of the T-sleeve Technique

Abstract

Aim: The aim of this study to reveal preliminary results of our Toupet-sleeve technique in morbid obese patients with symptomatic gastroesophageal reflux disease (GERD) and compare their outcomes with laparoscopic sleeve gastrectomy (LSG) patients’ outcomes. Methods: The study included 103 patients who underwent primary LSG between March 2018 and October 2020 and 18 patients who underwent partial T-sleeve. Patients were stratified into 2 groups according to the surgical technique. All of the patients had preoperative symptomatic GERD. Patients were reevaluated with regard to GERD symptoms and weight loss in the postoperative period. Two groups’ data were compared. Results: The mean age of the patients was 39.2±10.2 years (63% female), and the mean body mass index was 43.2±6.4 kg/m2. The median operative time was 93 minutes (75 to 110 min) in group A (primary LSG) and 110 minutes (90 to 120 min) in group B (partial T-sleeve). The mean body mass index decreased to 28±4.5 kg/m2 in group A and 25.8±3.5 kg/m2 in group B at 12 months after the surgery. At the 12th month, the patients were reevaluated for GERD symptoms. Reflux symptoms were found to be resolved in 62% of the patients (n=64) in group A, while 32% of the patients (n=39) had persistent GERD symptoms. In group B, all of the patients had discontinued proton pump inhibitors postoperatively, and GERD symptoms were completely resolved in 94% of these patients (n=17). Conclusions: The present study showed that T-sleeve provides a very good weight loss and reflux control in patients with symptomatic GERD with morbid obesity in the short-term period. This technique can be proposed in some cases as a primary treatment modality. High numbers of patients and longer follow-up are needed.

Laparoscopic sleeve gastrectomy combined with Toupet fundoplication (T‐sleeve): A short report of a Japanese obesity patient with gastroesophageal reflux disease

“…The surgical procedure for T‐sleeve has not been standardized. Türkçapar et al 5 first reported on T‐sleeve. They reported that the left‐side wrap was created after sleeve gastrectomy.…”

“…To prevent GERD after LSG, the combination of LSG and fundoplication has been explored. [3][4][5] This case report describes our experience of LSG with Toupet fundoplication (T-sleeve) for a Japanese obesity patient with GERD.…”

“…Roux‐en‐Y gastric bypass (RYGB), which is the preferred procedure for severe obesity with GERD, is less suitable for Japanese individuals due to higher risk of gastric cancer. To prevent GERD after LSG, the combination of LSG and fundoplication has been explored 3–5 . This case report describes our experience of LSG with Toupet fundoplication (T‐sleeve) for a Japanese obesity patient with GERD.…”

Is There a Relationship Between Helicobacter Pylori and GERD Before Laparoscopic Sleeve Gastrectomy?

“…Scores of 4 points and above were considered symptomatic GERD. Patients were re-evaluated for GERD with the same scoring system at the earliest 12 months after LSG 15–17. All patients underwent preoperative endoscopy (Olympus GIF-H180J), under the guidance of an anesthesiologist with sedation anesthesia (0.05 mg/kg midazolam, 1 to 2 mg/kg propofol).…”

“…Patients were re-evaluated for GERD with the same scoring system at the earliest 12 months after LSG. [15][16][17] All patients underwent preoperative endoscopy (Olympus GIF-H180J), under the guidance of an anesthesiologist with sedation anesthesia (0.05 mg/kg midazolam, 1 to 2 mg/kg propofol). Esophagitis was classified according to the Los Angeles classification.…”