Gastric Bipartition with Functional Duodenum Exclusion (GBp-FDE) as a Possible Surgical Conversion of Sleeve Gastrectomy in Patients with De Novo GERD and Obesity Recidivism: Preliminary Results of a Case Series
Year: 2025
Type: article
Abstract: BACKGROUND Sleeve gastrectomy (SG) is widely used in obesity treatment, although it is associated with new onset of gastroesophageal reflux disease (de novo GERD) and weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional procedure for GERD, though it offers limited additional weight loss. Ileal-based procedures have demonstrated superior outcomes regarding weight loss but have uncertain results in GERD. This study presents preliminary findings on gastric bipartition with functional duodenal exclusion (GBp-FDE) as a revisional approach following SG in this scenario. CASE REPORT A retrospective data analysis was conducted on 10 patients who underwent GBp-FDE due to de novo GERD and obesity recurrence after SG (mean BMI: 37.2±3.2 kg/m²). Nine patients presented with hiatal hernia and 8 with sleeve dilation. GERD was assessed pre- and postoperatively using a validated questionnaire, endoscopy, and contrast radiology. The surgical technique involved a pre-pyloric antroileostomy in Roux-en-Y configuration using a 40% proportion biliopancreatic limb. One-year postoperative findings included pyloric spasm (endoscopy), very preferential contrast flow to the ileum (radiology), and endoscopic access preservation to the duodenum. GERD symptoms resolved in 90% (P=0.0059) and esophagitis healed in 80% (P=0.008), likely due to gastric decompression. Mean percent total weight loss and percent excess weight loss were 35.2±6.6 and 108.0±11.14, respectively. CONCLUSIONS GBp-FDE seems to be a promising surgery for managing de novo GERD and obesity recurrence after SG, through SG pouch decompression and ileal stimuli, promoted by the antroileostomy. Further controlled studies with extended follow-up are necessary to validate these findings.
Source: American Journal of Case Reports
DOI: 10.12659/ajcr.950798
Authors: Victor Ramos Mussa Dib, Carlos Augusto Scussel Madalosso, Paulo Reis Rizzo Esselin De Melo, Almino Cardoso Ramos, Luiz Alfredo Vieira D\'Almeida, Luciano Antozzi, José María Balibrea del Castillo, Patrick Noel, Manoel Passos Galvão Neto, Sonja Chiappetta, Fernando de Barros, André Teixeira, Elinton Adami Chaim, Ricardo Zorron, Eudes Paiva de Godoy, Caio Gustavo Gaspar de Aquino, Giorgio Alfredo Pedroso Baretta, Diogo Swain Kfouri, Hiroji Okano Júnior, Nilton Tokio Kawahara, Augusto Cláudio de Almeida Tinoco, Nicholas Tavares Kruel, Joe Joaquim Waltrick Junior, Carlos Frota Dillenburg, Félix Antônio Insaurriaga Dos Santos, Rafael Antoniazzi Abaid, Carlos Eduardo Alves Da Costa, Gabriela Trentin Scortegagna, Geovana F. Silva, Halit Eren Taskin, Ricardo M. Nassar, Laurent Abram Layani, Daniel Oscar Caiña, Manuel Aceves Avalos, Jorge Bravo Lópes, José Sergio Verboonen Sotelo, Ramon Vilallonga Puy, Christine Karolina Stier, Carlos Eduardo Domene, Paula Volpe, Amador García Ruiz de Gordejuela, Luis Poggi, Antônio Torres, Miguel Ángel Carbajo, Italo Braghetto, Rui Ribeiro, Chetan Parmar
Institutions: Gastro Obeso Center, Hospital Pró-Cardíaco, Hospital Universitari Germans Trias i Pujol, Assistance Publique Hôpitaux de Marseille, Orlando Health, Universidade Federal Fluminense, Universidade Estadual de Campinas (UNICAMP), Hospital CUF Descobertas, Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Hospital Israelita Albert Einstein, Universidade de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Hospital São José do Avaí, Universidade Federal de Pelotas, Istanbul University-Cerrahpaşa, Istanbul University, Fundación Santa Fe de Bogotá, University of Chile, Vall d'Hebron Hospital Universitari, Heidelberg University, University Medical Centre Mannheim, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Whittington Hospital, Whittington Health NHS Trust
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4416727037