title: Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence.
abstract: Crural closure in addition to laparoscopic sleeve gastrectomy (LSG) represents a valuable option for the synchronous management of morbid obesity and hiatal defects, providing good outcomes in terms of weight loss and gastroesophageal reflux disease (GERD) symptoms control. The aim of this prospective study was to evaluate the safety and effectiveness of the reinforced cruroplasty during LSG compared with a concurrent group of simple cruroplasty.
  
  
  
  The study groups included 96 morbidly obese patients who underwent simultaneous LSG and cruroplasty. Group A: 48 patients with hiatal areal defect <4 cm(2) and normal pillars (simple posterior cruroplasty); group B: 48 patients with hiatal areal defect >4 and <8 cm(2) with weakness of the right pillar (on-lay synthetic absorbable mesh-reinforced cruroplasty). Upper GI symptoms were assessed by Roma III standard questionnaire. Endoscopy, imaging, esophageal 24-h pH monitoring and HR manometry were performed in cases of persistent or recurrent symptoms after surgery.
  
  
  
  Mortality rate was nil. The conversion rate to open was 1 %. Intra-operative diagnosis of hiatal hernia occured in 41 patients (42.7 %). Mesh-related complications were none. Perioperative complications occurred in four patients (4.1 %). After 19- to 21-month follow-up, GERD symptom remission occurred in 89 % of patients. GERD symptoms were detected postoperatively in eight patients: six in group A (five symptomatic and radiological recurrences and one persistent) and two in group B (one persistent and one de novo GERD) (P < 0.05).
  
  
  
  The synthetic absorbable mesh offers an effective option for crural repair during LSG with no clinical recurrences at 19 months. The midterm results of this prospective comparative study evaluating two different technical options for cruroplasty confirm that the simultaneous procedures are safe and cruroplasty is effective in mild-to-moderate GERD control .
authors.affiliation: Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnologies, Bariatric Center of Excellence IFSO EU, "La Sapienza" University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Ruscio
authors.affiliation: Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnologies, Bariatric Center of Excellence IFSO EU, "La Sapienza" University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.|Gastroenterology Surgical Center, Faculty of medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelgawad
authors.affiliation: Department of Internal Medicine and Medical Disciplines, "La Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Badiali
authors.affiliation: Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnologies, Bariatric Center of Excellence IFSO EU, "La Sapienza" University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Iorio
authors.affiliation: Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnologies, Bariatric Center of Excellence IFSO EU, "La Sapienza" University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rizzello
authors.affiliation: Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnologies, Bariatric Center of Excellence IFSO EU, "La Sapienza" University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cavallaro
authors.affiliation: Department of Internal Medicine and Medical Disciplines, "La Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Carola
authors.initials: C
authors.lastname: Severi
authors.affiliation: Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnologies, Bariatric Center of Excellence IFSO EU, "La Sapienza" University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy. gianfranco.silecchia@uniroma1.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D011446:Prospective Studies; D013526:Surgical Mesh
keywords: Bio-A absorbable mesh; Cruroplasty; GERD; Hiatal hernia; Morbid obesity; Sleeve gastrectomy