Robotic or laparoscopic SLEEVE-DOR (sleeve gastrectomy with anterior Dor 180° fundoplication) for obesity: preliminary results of a series of 80 patients

摘要

Aims: Sleeve gastrectomy (SG) is currently the most performed bariatric surgery worldwide. For patients with obesity and symptomatic gastroesophageal reflux disease (GERD), the indication of SG is a matter of concern due to the possibility of worsening or de novo reflux in the postoperative follow-up. A new method, the combination of a 180-degree anterior fundoplication (SLEEVE-DOR) using only one barbed nonabsorbable suture, is proposed to allow the use of SG for this set of patients aiming to minimize the occurrence of de novo GERD. The study aims to evaluate the safety, feasibility and efficacy of SG with SLEEVE-DOR for the therapy of patients with obesity. Methods: The study describes the largest series of SG combined with anterior hemifundoplication. Since June 2018, all patients with indications for bariatric surgery and having proton pump inhibitor (PPI) therapy for symptomatic reflux at least 6 months before surgery were prospectively documented. All operations were performed laparoscopically (45) or with a robotic DaVinci platform (35). Clinical data were collected from our bariatric center database. The primary outcomes included technical success, perioperative complications and mortality, and the resolution of symptomatic gastroesophageal reflux after the SLEEVE-DOR procedure. Results: The procedure was successfully performed for all patients (n = 80). Mean operative time was 60.1 min. All patients started oral fluids one hour after the surgery and were discharged between 1st and 3rd postoperative day. Postoperative complications occurred in three patients, with one leak, one peritonitis due to colonic thermic lesion from adherences, and one postoperative death due to massive pulmonary embolism. Four patients claimed intractable reflux between 3 and 6 months and were later converted to a Roux-en-Y gastric bypass (RYGB). The remaining patients experienced complete resolution of reflux symptoms in the 6-month follow-up. The percentage of excess weight loss (%EWL) was 58.5% on postoperative 12 months. Conclusions: SLEEVE-DOR with one nonabsorbable barbed suture is a safe, effective, and technically simple alternative procedure to allow the performance of SG for morbidly obese patients with preoperative mild symptomatic gastroesophageal reflux, especially for patients with severe obesity as the first step operation.