Evaluation of the effectiveness of the antireflux cuff from the round ligament of the liver in obese patients after longitudinal gastrectomy

The purpose. The objective of this study is to evaluate the efficacy and safety of forming an antireflux sleeve from the round ligament of the liver in obese patients after longitudinal gastrectomy (LG) in the prevention of gastroesophageal reflux disease (GERD) compared with standard LG with cruroraphy. Material and methods. A prospective study (2018–2023) included 82 obese patients (BMI ≥35 kg/m²) with confirmed GERD. The primary cohort (n = 42) was administered GERD with the formation of an antireflux cuff from the round ligament of the liver and posterior cruroraphy; the control group (n = 40) received only GERD with cruroraphy. The assessment encompassed a range of methodologies, including clinical (GSRS, SF-36 questionnaires), instrumental (FEGDS, pH-metry, fluoroscopy), and the Clavien-Dindo classification of complications. Statistical analysis was performed using the Mann-Whitney and χ² criteria. Results. Efficiency. After a 12-month period, a complete disappearance of GERD symptoms was observed in 92.9 % of patients in the primary cohort, as compared to 85% in the control group (p = 0.033). The recurrence of gastroesophageal reflux disease (GERD) was observed to occur in 2.4 % (1/42) of the subjects in the study, as compared to 15 % (6/40) of the subjects in the study. Complications. In the main group, 2.4 % of mild complications (bleeding) were registered, while in the control group, 5 % of cases required repeated surgical interventions (e.g., gastric bypass, teres-plasty). Instrumental data. In the primary cohort, Index DeMeester registered at 7.1 (compared to 9.3 in the control group), while the proportion of time spent with a pH below 4 was recorded at 1.7 % (versus 1.38 %). Quality of life. The GSRS questionnaire revealed a statistically significant improvement in the "reflux syndrome" scale among the primary cohort (p = 0.004). The SF-36 demonstrated a significant improvement in the "General health" (77 versus 67 points) and "Social functioning" (100 versus 88) scales. Conclusion. The antireflux cuff, fabricated from the round ligament of the liver, has been demonstrated to reduce the risk of Gastroesophageal Reflux Disease (GERD) recurrence, enhance quality of life, and is deemed safe in patients post-Procedure Related to the Liver (PR). The method has the potential to become a standard in bariatric surgery for patients with obesity and concomitant GERD.