Options for the surgical technique of laparoscopic sleeve gastrectomy for prevention and treatment of gastroesophageal reflux in patients with obesity

Laparoscopic sleeve gastrectomy (LSG) is the most common intervention performed to correct obesity and associated metabolic disorders. At the same time, one of the most frequently developing negative effects after LSG is the occurrence of gastoesophageal reflux «de novo» or increased symptoms of gastroesophageal reflux disease. Today, a number of modified surgical approaches have been proposed for the prevention or treatment of reflux after LSG, and all proposed operations can be divided into three groups. The first group of interventions includes operations in which the algorithm for forming the gastric «sleeve» remains unchanged, but additional manipulations are carried out with the surrounding tissues. The second group of interventions includes modified techniques, in which changes in surgical technique affect the process of formation of the gastric «sleeve», which is complemented by the formation of anti-reflux mechanisms. The third group of operations includes interventions in which the formation of a gastric «sleeve» is combined with the implementation of techniques corresponding to one or another type of fundoplication. On the other hand, none of the methods has received sufficient distribution, although the most frequently used combinations of LSG with cruroplasty and with fundopolication. At the same time, there is no standardization of approaches to the surgical techniques of many types of operations, as well as to the criteria for their selection. The results of the use of antireflux variants of LSG also remain controversial. However, given the importance and prevalence of the problem under consideration, it seems necessary to further study the characteristics and results of anti-reflux variants of LSG, as well as the development of optimal approaches for their clinical use.