Stomach intestinal pylorus sparing surgery (SIPS) with laparoscopic fundoplication (LF): a new approach to gastroesophageal reflux disease (GERD) in the setting of morbid obesity

Daniel Cottam,Austin Cottam,LeGrand Belnap,Amit Surve,Samuel Cottam,Hinali Zaveri,Walter Medlin,Christina Richards

doi:10.1186/s40064-015-1396-6

Daniel Cottam, Austin Cottam + Show 6 more

Open Access

https://doi.org/10.1186/s40064-015-1396-6

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Journal: SpringerPlus	Publication Date: Oct 13, 2015
Citations: 27	License type: CC BY 4.0

Affiliation: Polytechnic University of Bari

Abstract

The increase in the prevalence of obesity and gastroesophageal reflux disease (GERD) has paralleled one another. Laparoscopic fundoplication (LF) (Nissen or Toupet) is a minimally invasive form of anti-reflux surgery. The duodenal switch is a highly effective weight loss surgery with a proven record of long term weight loss success. However, fundoplication alone does not give satisfactory results when used for GERD in morbidly obese patients. Here we present a novel approach combining stomach intestinal pylorus sparing surgery (SIPS) with LF for morbidly obese patients with GERD. The data from patients who underwent the SIPS procedure along with LF in past year was retrospectively analyzed. The variables collected were age, sex, height, weight, intra-operative and post-operative complications, length of stay, operative time, and estimated blood loss. All revisions were excluded. Descriptive statistics such as mean and standard deviation were used to analyze the data. The total sample size of the study was 5 patients, with a mean age of 59.6 ± 16.4 years, a mean weight of 292.1 ± 73.6 lbs., and a mean body mass index (BMI) of 43.4 ± 6.3. Weight loss patterns were the same as those without LF. All the 5 patients had resolution or improvement in their GERD symptoms within 6 months. SIPS with LF provides substantial and sustained weight loss and GERD resolution. Long term follow ups and further study on this novel surgical technique is recommended.

Highlights

Morbid obesity is a chronic disease which leads to progressive co-morbidities, socio-economic problems, undesirable quality of life, and earlier death
Gastroesophageal reflux disease (GERD) is a common comorbidity associated with obesity (Hampel et al 2005)
Laparoscopic fundoplication (LF) does not give satisfactory results in treatment for gastroesophageal reflux disease (GERD) in morbidly obese patients since obesity predisposes the patient to high rates of laparoscopic fundoplication (LF) failure (Antanavicius et al 2008; Makris et al 2009)

Summary

Introduction

Morbid obesity is a chronic disease which leads to progressive co-morbidities, socio-economic problems, undesirable quality of life, and earlier death. To date only metabolic/bariatric surgeries have achieved significant weight loss, with the corresponding correction or improvement of co-morbidities, improving quality of life. Duodenal switch (DS) is one of the most efficacious forms of bariatric surgical therapy for the morbidly obese available to the clinician (Hess et al 2005; Buchwald et al 2004). Gastroesophageal reflux disease (GERD) is a common comorbidity associated with obesity (Hampel et al 2005). We report a novel technique involving both LF and a modification of the DS called SIPS (stomach and intestinal pyloric sparing surgery) which together provide optimal weight loss and optimal anti-reflux characteristics while limiting complications associated with another common weight loss intervention for GERD in the setting of morbid obesity(the laparoscopic gastric bypass [LRYGBP])

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