Cardiopexy Using the Round Ligament (Rampal Technique): An Alternative to the Gastric Bypass for Severe Reflux after...

Severe gastroesophageal reflux disease (GERD) following sleeve gastrectomy (SG) remains a major therapeutic challenge in bariatric surgery. The gold-standard surgical approach is represented by the conversion to Roux-en-Y gastric bypass (RYGB), which carries a significant risk of long-term complication rate. The present study evaluates the efficacy and safety of an alternative procedure-the Round Ligament Cardiopexy (Rampal Technique, RLC)-in patients with severe, invalidating reflux following SG.

This is a single-center, retrospective study reviewing all patients who underwent Rampal cardiopexy for severe reflux after SG between June 2020 and October 2024. Demographic data, clinical characteristics, pre- and postoperative findings, and quality-of-life outcomes (Reflux-Qual® Simplified, RQS®) were collected. The primary endpoint was improvement in reflux and regurgitation symptoms; secondary endpoints included morbidity and mortality.

Six female patients (mean age: 40.8 ± 15.7 years) were included, with a mean interval of 6 ± 3 years between SG and CR. All procedures were completed laparoscopically. A significant improvement in reflux symptoms was observed postoperatively (P = .02), with complete resolution of regurgitations and marked reduction of acid reflux. RQS® scores improved from 21 ± 4.6 to 15.7 ± 7.5 (P = .52). No mortality occurred. Early morbidity was 33% (two transient dysphagias), and late morbidity was 17% (one stricture requiring dilation).

The Rampal cardiopexy could represent a safe, effective, and minimally morbid alternative to conversion to RYGB for refractory reflux following SG. Additional further evaluation in larger, prospective studies is needed to confirm its long-term benefits. This technique should be better known among bariatric surgeons to expand the therapeutic options for managing post-sleeve GERD.