Laparoscopic Toupet-Sleeve gastrectomy in morbid obese patients with preoperative gastro-esophageal reflux: a 4-year follow-up cohort study

Aim: To assess the 4-year outcomes after Toupet-Sleeve (TS) gastrectomy in morbid obese patients with concomitant preoperative gastro-esophageal reflux disease (GERD). Material and methods: The study group consisted of 19 consecutive patients operated on between August 2017 and February 2019. There were 5 men and 14 women with a mean body mass index (BMI) of 43 +/- 5 kg/m(2) and a mean age of 42 +/- 15 years. A retrospective analysis of database and telephone interview of patients who defaulted clinic follow-up was conducted. The main study end-points were weight loss and success of surgery, defined as no need for conversion and %EWL > 50%. Resolution of GERD was a secondary end-point. Results: No patient was lost for follow-up. Nadir weight loss was reached after a follow-up of one year: mean BMI was 32 +/- 5 kg/m(2), %EWL 61 +/- 21% and %TWL 24 +/- 7%. Thereafter, we observed a progressive weight regain over time. With a mean follow-up of 51 +/- 6 months, mean BMI was 36 +/- 8 kg/m(2), %EWL 43 +/- 35% and %TWL 16 +/- 12%. Two patients were converted to another bariatric procedure because of dysphagia and fundus dilatation or because of insufficient weight loss. The overall surgical success rate was 32% (6/19). Resolution of GERD without any PPI treatment was noted in 88% (15/17) of the non-converted patients. Conclusion: In our experience, with a 4-year follow-up, TS is associated with a significant risk of conversion, a moderate weight loss and a poor surgical success rate.