Cardiopexy with Ligamentum Teres in Patients with Hiatal Hernia and Previous Sleeve Gastrectomy: An Alternative Treatment for Gastroesophageal Reflux Disease

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. 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. 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. 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.