title: Cardiopexy with Ligamentum Teres in Patients with Hiatal Hernia and Previous Sleeve Gastrectomy: An Alternative Treatment for Gastroesophageal Reflux Disease.
abstract: BACKGROUND
  Fifty percent of patients who have undergone sleeve gastrectomy have gastroesophageal reflux disease (GERD). Surgical reinforcement of the lower esophageal sphincter is necessary to prevent acid reflux. Here, we describe ligamentum teres cardiopexy, a surgical technique that reinforces the lower esophageal sphincter and restores its competence with a new valve, in patients with previous sleeve gastrectomy and hiatal hernia.
  
  
  METHODS
  Included in the study were 15 patients (age, 35.6 ± 15.2 years; 13 females [86.6 %]; mean pre-cardiopexy body mass index, 21.94 kg/m(2)) with sleeve gastrectomy who presented with hiatal hernia and gastroesophageal reflux disease and underwent ligamentum teres cardiopexy. In this procedure, the ligamentum teres is released from its umbilical connection and the hernia reduced by manual traction, freeing the last 3-5 cm of esophagus in the abdomen. The distal ligamentum teres is fixed with one stitch to the apex of the angle of His, one at the gastroesophageal junction, and one joining the gastric fundus to the esophagus. The remainder of the ligamentum teres is fixed over itself with four to six stitches, forming a necktie cardiopexy. The procedure concludes with diaphragmatic crus closure.
  
  
  RESULTS
  After 6 months, 13 patients (86.6 %) achieved successful results, defined as resolution of GERD, no proton-pump inhibitor (PPI) use, and manometry measurement over 12 mmHg after surgery. Two patients (13.3 %) required continued proton-pump inhibition.
  
  
  CONCLUSIONS
  Ligamentum teres cardiopexy combined with closure of the gastric crus is a good alternative treatment for gastroesophageal reflux disease in patients with previous sleeve gastrectomy and hiatal hernia.
authors.affiliation: Division of Gastric Surgery, Hospital Ángeles León, Guanajuato, Mexico, lgdominguez@hotmail.com.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Gálvez-Valdovinos
authors.forename: José Luis
authors.initials: JL
authors.lastname: Cruz-Vigo
authors.forename: Ernesto
authors.initials: E
authors.lastname: Marín-Santillán
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Funes-Rodríguez
authors.forename: Gustavo
authors.initials: G
authors.lastname: López-Ambriz
authors.forename: Luis Gerardo
authors.initials: LG
authors.lastname: Domínguez-Carrillo
mesh_terms: D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods; D005748:Gastric Fundus / Q000601:surgery; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D000069590:Round Ligaments / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult