Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy

Background Severe reflux after sleeve-gastrectomy (SG) often requires conversion to Roux-en-Y-Gastric Bypass (RYGB). We performed laparoscopic Ligamentum Teres Cardiopexy (LLTC) as an alternative operation. Materials & Methods: Ten patients had LLTC between June 2019–June 2020. Pre-operative work-up included Barium swallow, upper endoscopy with pH monitoring. The percent excess body mass index (%EBMI) loss before LLTC was 70 ± 0.2%. Results Pre-operative DeMeester score was 69 ± 50 (normal = 14.72). All patients underwent repair of hiatal hernia and gastric plication in addition to LLTC. The average operative-time was 110 ± 26 min. The follow up was 7 ± 3 months. Eight patients had resolution of their reflux. Two patients resumed medication for recurrent mild reflux. Conclusion LLTC is a safe technique and may be considered a rescue operation in lieu of conversion to RYGB in managing severe reflux after SG. Long term results are needed to confirm its durable effectiveness.