To Fix or Not to Fix: Effect of Gastropexy on Esophageal Manometric Values Post Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is widely performed for severe obesity but is associated with postoperative gastroesophageal reflux disease (GERD) and esophageal motility disorders. Gastropexy has been proposed to preserve gastric anatomy and reduce complications.

To evaluate the effect of gastropexy on esophageal manometric values following LSG.

A randomized controlled study was conducted on 40 patients undergoing LSG at our Hospital, (20 with gastropexy, 20 without). Esophageal manometry was performed preoperatively and 6 months postoperatively. Postoperative symptoms, complications, and percentage of total body weight loss (%TBWL) were assessed.

In the non-gastropexy group, there was a significant decrease in lower esophageal sphincter (LES) resting pressure and distal contractile integral (DCI) postoperatively (p = 0.002 and p = 0.01, respectively). The gastropexy group showed preserved LES pressure and DCI. Postoperative GERD symptoms, vomiting, and food intolerance were significantly less in the gastropexy group (p < 0.05). There was no significant difference in %TBWL between groups (p = 0.86). Operative time was longer in the gastropexy group (p < 0.001).

Gastropexy step during LSG may play a role in preservation of the esophageal manometric values and reduces postoperative GERD and vomiting, although it increases operative time. Larger long-term trials are needed for confirmation.