title: Laparoscopic Management of Severe Reflux After Sleeve Gastrectomy, in Selected Patients, Without Conversion to Roux-en-Y Gastric Bypass.
abstract: BACKGROUND
  Treatment of severe reflux after laparoscopic sleeve gastrectomy (LSG) may require conversion to Roux-en-Y gastric bypass (RYGB). We conducted a pilot study to evaluate the feasibility and effectiveness of performing laparoscopic anterior fundoplication with posterior crura approximation (LAF/pCA), in selected patients, to correct the reflux without conversion to RYGB.
  
  
  METHODS
  From October 2012 to April 2013, 6 patients with confirmed severe de novo reflux after LSG were treated with LAF/pCA.
  
  
  RESULTS
  All patients were females with a mean age of 41.5±14.2 years. All patients had lost weight after initial LSG. The percentage excess body mass index (BMI) loss (%EBL) was 61.2±33.2%. The mean time from the initial LSG to LAF/pCA was 33.2±12.5 months. Four patients had reduction of gastric fundus size. One patient required resleeving. Reflux resolved immediately in all patients with a follow-up of 18.5±2.7 months. All patients continued to lose weight, with %EBL reaching 75.5±22.9% and a mean BMI of 32±7.3 kg/m(2).
  
  
  CONCLUSIONS
  LAF/pCA with reduction of gastric fundus size, when needed, may be considered an alternative option to correct severe reflux after LSG in selected patients.
authors.affiliation: 1 St. John Hospital & Medical Center , Detroit, Michigan.|2 William Beaumont Hospital , Grosse Pointe, Michigan.
authors.forename: Abdelkader
authors.initials: A
authors.lastname: Hawasli
authors.affiliation: 1 St. John Hospital & Medical Center , Detroit, Michigan.
authors.forename: Ara
authors.initials: A
authors.lastname: Bush
authors.affiliation: 1 St. John Hospital & Medical Center , Detroit, Michigan.|2 William Beaumont Hospital , Grosse Pointe, Michigan.
authors.forename: Bradley
authors.initials: B
authors.lastname: Hare
authors.affiliation: 1 St. John Hospital & Medical Center , Detroit, Michigan.|2 William Beaumont Hospital , Grosse Pointe, Michigan.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Meguid
authors.affiliation: 1 St. John Hospital & Medical Center , Detroit, Michigan.
authors.forename: Naga
authors.initials: N
authors.lastname: Thatimatla
authors.affiliation: 1 St. John Hospital & Medical Center , Detroit, Michigan.
authors.forename: Susan
authors.initials: S
authors.lastname: Szpunar
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005743:Gastrectomy / Q000009:adverse effects*; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D018579:Patient Selection; D010865:Pilot Projects; D016896:Treatment Outcome