Abstract Introduction Laparoscopic sleeve gastrectomy (LSG) is one of the most widely used techniques in bariatric surgery; however, it has been increasingly associated with the development or worsening of gastroesophageal reflux disease (GERD) in the postoperative period creating significant clinical challenges. Traditionally, gastric bypass has been recommended in patients with pre-existing GERD, often displacing LSG as a surgical option. Recent literature, including the review by Masood et al. (2024), highlights the need for individualized and stepwise management approaches for post-SG GERD, underscoring the absence of a standardized preventive method. Gastropexy has traditionally been implemented to reduce the risk of mechanical complications such as torsion, staple line leak, or bleeding; however, its potential role in mitigating reflux symptoms has not been thoroughly evaluated. This study evaluates whether the systematic incorporation of gastropexy as a technical maneuver during LSG can reduce the incidence and severity of postoperative GERD in patients with prior symptoms. This approach is particularly relevant for patients with lower body mass index (BMI) or those who, for personal or clinical reasons, wish to avoid malabsorptive procedures such as gastric bypass. Proposing technical modifications that optimize LSG outcomes could expand therapeutic options without compromising safety or efficacy. Methods A retrospective comparative cohort study was conducted at the International Institute of Metabolic Medicine, a high-volume center in Tijuana, Baja California, Mexico. A total of 240 patients with confirmed preoperative GERD who underwent LSG with or without gastropexy between January 2019 and March 2025 were included. GERD symptoms were assessed at 3, 6, and 12 months using a validated scale (GERD Score) and classified by clinical severity (mild, moderate, severe). A longitudinal subanalysis was performed in patients with complete follow-up. Comparisons were made using chi-square tests, and clinical changes were categorized as improvement, stability, or worsening. Results Gastropexy was performed in 40.8% of cases. At 3 and 6 months, the prevalence of GERD symptoms was significantly lower in the gastropexy group (46.9% and 37.5%) compared to the non-gastropexy group (78.9% and 63.2%) (P = 0.0121 and P = 0.0238, respectively). At 12 months, 70.7% of patients in the gastropexy group showed clinical improvement of GERD, compared to 50.0% in the non-gastropexy group. Only 2.4% of patients with gastropexy worsened, versus 14.7%without gastropexy. The longitudinal subanalysis (n = 57) revealed a trend toward sustained symptom resolution in the gastropexy group through month 6, while the non-gastropexy group showed greater symptom persistence and recurrence throughout follow-up. Recurrence at 12 months was clinically associated with weight regain or plateau and discontinuation of nutritional follow-up. Conclusion Gastropexy during LSG is associated with a more favorable postoperative evolution of GERD.
Morales et al. (Thu,) studied this question.