title: Laparoscopic partial sleeve gastrectomy with fundoplication for gastroesophageal reflux and delayed gastric emptying.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Surgery, Concord and Repatriation Hospitals, Hospital Road, Concord, NSW, 2139, Australia, drlepage@oclinic.com.au.
authors: Philip A
authors: PA
authors: Le Page
authors: David
authors: D
authors: Martin
mesh_terms: D000368:Aged; D004941:Esophagitis / Q000209:etiology; D005260:Female; D018662:Fundoplication; D005743:Gastrectomy / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D018589:Gastroparesis / Q000150:complications / Q000601:surgery*; D005773:Gastroscopy; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
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