Ligamentum Teres Cardiopexy for Refractory Gastroesophageal Reflux Disease after Sleeve Gastrectomy: A Prospective Observational Study

Background: Gastroesophageal reflux disease (GERD) is a recognized complication following laparoscopic sleeve gastrectomy (LSG) and represents one of the most common indications for revisional surgery. Conversion to Roux-en-Y gastric bypass is widely considered the standard revisional procedure; however, some patients decline this option. Ligamentum teres cardiopexy (LTC) has emerged as a potential anatomy-preserving alternative for managing reflux in selected patients. Materials and Methods: This prospective observational study included post-LSG patients with refractory GERD who underwent LTC between 2022 and 2024. Inclusion criteria were excess weight loss >60%, endoscopic evidence of GERD, and refusal of conversion to gastric bypass. The mean interval between LSG and LTC was 26 months. Pre- and postoperative evaluation included upper gastrointestinal endoscopy and GERD questionnaire (GERD-Q) assessment, with follow-up at 1 year. Results: Thirteen patients underwent LTC, and a complete 1-year follow-up was available for 11 patients. The mean age was 45 ± 7.2 years. Preoperatively, eight patients had Grade B reflux esophagitis, two had Grade C esophagitis, and one had Grade C esophagitis with a hiatal hernia. No major perioperative complications occurred. At 1 year, all patients demonstrated endoscopic resolution of esophagitis with restoration of normal lower esophageal sphincter tone. GERD-Q scores improved significantly from 14.7 ± 1.8 preoperatively to 6.5 ± 1.2 postoperatively ( P < 0.001). Two patients continued proton-pump inhibitor therapy despite normal endoscopic findings. Conclusion: LTC appears to be a safe and effective anatomy-preserving alternative for the management of GERD in selected postsleeve gastrectomy patients with satisfactory weight loss who decline conversion to gastric bypass.