The Effects of Adding Gastrojejunostomy to Sleeve Gastrectomy on GERD, Food Tolerance, and Weight Loss: A Randomized Study

Background: Bariatric surgery is a field in rapid evolution with continuous attempts by surgeons to offer procedures that achieve patients' objectives. The idea came out of a new combined bariatric procedure. The procedure is a hybrid of sleeve gastrectomy and gastric bypass, in which a sleeve gastrectomy is followed by a side to side gastrojejunal anastomosis combining advantages of both procedures: achieving restriction and malabsorption. Materials and Methods: Forty morbidly obese patients were randomly divided into two groups. Hybrid group: Twenty patients underwent the hybrid operation, which is a combined laparoscopic antrum preserving sleeve gastrectomy with loop gastrojejunostomy. Laparoscopic sleeve gastrectomy (LSG) group: Twenty patients underwent laparoscopic sleeve gastrectomy. The two groups were followed and assessed in several criteria (operative time, pressure measurement, duration of hospital stay, postoperative complications, weight loss, prevalence of gastroesophageal reflux disease (GERD), and food tolerance). Results: The hybrid procedure achieved higher %EWL compared with LSG. The study also showed that the intragastric pressure was lower in the hybrid group compared with the LSG group. It also showed a positive correlation between intragastric pressure and GERD score and a negative one between intragastric pressure and Suter's food tolerance score. Conclusion: The hybrid procedure achieved higher %EWL, lower intragastric pressure, and higher food tolerance scores compared with LSG. In addition, preservation of antrum carries the advantage of maintaining the access to the biliary tree through endoscopic retrograde cholangiopancreatography, an advantage over gastric bypass. Aim of Work: To assess the added value obtained by adding gastrojejunostomy to sleeve gastrectomy regarding excess weight loss, reflux symptoms, and food tolerance.