Posterior cruroraphy and antireflux cuff formation with the round ligament of the liver as a method of GERD treatment after gastric sleeve surgery

Background. According to the literature, the development of GERD and migration of the sleeve to the posterior mediastinum after gastric sleeve surgery (GSS) and SADI-S surgery ranges from 7 to 30% [13]. When GERD is diagnosed in patients before surgery, there are no clear instructions on surgical tactics [8]. Several surgical options are suggested, including surgery conversion to RYGB or MGB, as well as conservative treatment with proton pump inhibitors, H2-blockers, prokinetics, and deoxycholic acid in the postoperative period, which is sometimes unsuccessful [15]. We consider the solution of this problem an urgent task of modern bariatric surgery.Objective. Improving the quality of life of patients developing GERD after GSS and SADI-S, as well as reducing the number of complications in the postoperative period (reflux esophagitis, Barrett's esophagus).Material and methods. 379 GSS and 173 SADI-S procedures for morbid obesity were performed in the surgical department of RCH in 2016-2019. 52 patients developed full-blown GERD at various times after the surgery, and it required surgical correction in 6 of them.Revision involved posterior cruroraphy, strengthening of the esophageal hiatus with a mesh implant and the antireflux cuff formation with the round ligament of the liver.Results. No relapses of reflux esophagitis were registered within the postoperative period from three months to 1.5 years. After the revision antireflux surgeries, all symptoms of the disease regressed, and the quality of life of patients improved.