Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence

Sara Ruscio; Mohamed Abdelgawad; Danilo Badiali; Olga Iorio; Mario Rizzello; Giuseppe Cavallaro; Carola Severi; Gianfranco Silecchia

doi:10.1007/s00464-015-4487-0

Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence

Surg Endosc. 2016 Jun;30(6):2374-81. doi: 10.1007/s00464-015-4487-0. Epub 2015 Oct 1.

Authors

Sara Ruscio¹, Mohamed Abdelgawad^{1

2}, Danilo Badiali³, Olga Iorio¹, Mario Rizzello¹, Giuseppe Cavallaro¹, Carola Severi³, Gianfranco Silecchia⁴

Affiliations

¹ 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.
² Gastroenterology Surgical Center, Faculty of medicine, Mansoura University, Mansoura, Egypt.
³ Department of Internal Medicine and Medical Disciplines, "La Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
⁴ 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.

PMID: 26428202
DOI: 10.1007/s00464-015-4487-0

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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 .

Keywords: Bio-A absorbable mesh; Cruroplasty; GERD; Hiatal hernia; Morbid obesity; Sleeve gastrectomy.

MeSH terms

Absorbable Implants
Adult
Female
Follow-Up Studies
Gastrectomy / methods*
Gastroesophageal Reflux / surgery*
Hernia, Hiatal / surgery*
Humans
Laparoscopy*
Male
Obesity, Morbid / surgery
Prospective Studies
Surgical Mesh*