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Publications

Journal Article Ahead of print

PubMed: 42159765 DOI: 10.1007/s00423-026-04063-w

Surgical management of gastroesophageal reflux disease after sleeve gastrectomy with satisfactory weight loss: a SOFFCO-MM practice survey.

Langenbecks Arch Surg

Authors: Francesco Abboretti, Tigran Poghosyan, Styliani Mantziari, François Pattou, Andrea Lazzati, Marie-Cécile Blanchet, Claire Blanchard, Jean-Marc Catheline, Laurent Genser, Fabian Reche, Maud Robert, Caroline Gronnier, Damien Bouriez

Affiliations

  • Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
  • Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
  • Université Paris Cité, AP-HP. Nord, Hôpital Bichat Claude Bernard, Service de Chirurgie Digestive UMR 1149, Inserm, Paris, France.
  • Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
  • Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
  • Service de chirurgie générale et endocrinienne, CHU de Lille, Lille, France.
  • Inserm, Lille Pasteur Institute, EGID, U1190, université Lille, CHU Lille, Lille, France.
  • Department of Digestive, Bariatric and Endocrine Surgery, HU Paris Seine-Saint-Denis, AP-HP, Avicenne Hospital, Bobigny, France.
  • HeKA INSERM, INRIA Paris, Centre de Recherche des Cordeliers Paris, Université Paris Cité, Paris, France.
  • Centre Lyonnais de chirurgie digestive, CSO Sauvegarde Lyon, Lyon, France.
  • Chirurgie cancérologique, digestive et endocrinienne, institut des maladies de l'appareil digestif (IMAD), CHU de Nantes, Nantes, France.
  • CHU de Nantes, l'institut du thorax, Nantes université, CNRS, Inserm, Nantes, France.
  • Service de chirurgie digestive, centre hospitalier de Saint-Denis, Saint- Denis, France.
  • Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, Pitié-Salpêtrière University Hospital, 47-83 boulevard de l'Hôpital, Paris, 75013, France.
  • Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, INSERM, TIMC, Grenoble, 38000, France.
  • Department of Digestive Surgery, CHU Grenoble Alpes, Grenoble, France.
  • Service de chirurgie digestive et bariatrique, hospices Civils de Lyon, hôpital Edouard-Herriot, Lyon, France.
  • Esophagogastric Surgery Unit, Haut Lévêque Hospital, Centre Hospitalier Universitaire Bordeaux, France, University of Bordeaux, Bordeaux, France.
  • Esophagogastric Surgery Unit, Haut Lévêque Hospital, Centre Hospitalier Universitaire Bordeaux, France, University of Bordeaux, Bordeaux, France.

Abstract

INTRODUCTION

Sleeve gastrectomy (SG) has become the most frequent bariatric surgery procedure. Secondary gastroesophageal reflux (GERD) may indicate conversion to Roux-en-Y gastric bypass (RYGB). However, in patients with sufficient weight loss, there is no clear answer in the literature as to whether RYGB should be performed with loop lengths leading to metabolic effect, or whether it should be performed solely for anti-reflux purposes. We aimed to evaluate current surgical practices and limb-length preferences among French-speaking bariatric surgeons managing GERD after SG in patients with satisfactory weight loss.

METHODS

A cross-sectional survey was distributed to members of the Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (SOFFCO-MM). The questionnaire included demographics, criteria for "satisfactory weight loss", diagnostic workup for GERD and RYGB technical configurations.

RESULTS

Fifty-three surgeons responded. Only 22.6% reported using a "standard" French RYGB configuration: alimentary limb (AL) 140-150 cm, biliary limb (BL) 70-80 cm). Most surgeons (60%) do not adjust the AL length based on weight loss, while 74% do not adjust the BL. Diagnostic approaches varied: 40% routinely performed pH monitoring, and only three surgeons required manometry.

CONCLUSIONS

While the majority of surgeons do choose RYGB to manage GERD after SG in patients with satisfactory weight loss, only a minority follow a strictly "standard" configuration (AL 140-150 cm, BL 70-80 cm). This indicates notable variability in limb-length selection, underscoring the need for more harmonized approaches and clearer guidelines.

MeSH

Weight Loss, Gastrectomy, Gastroesophageal Reflux, Surgeons