- Email: [email protected]
Comparison of staple line reinforcement technique in vertical sleeve gastrectomy performed by a single surgeon
Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
Results: total of 33 patients underwent sleeve gastrectomy at the age of 55 or older. The average age of this patient´s population was 61 (min 55/max 67) years. 91% of all patients could be followed up. The average follow up was 67 months. 1 (3%) complication, namely leakage of the staple line at the gastroesophageal junction, could be observed. %EWL was 45% (min 7.5/max 95). Weight regain of 10kg from the nadir could be seen in 9 (30%) patients. Concerning obesity related comorbidities an amelioration or even remission was reached in 57%. Conclusion: Sleeve gastrectomy in elderly patients can be considered as safe, efficient and reasonable therapy option in the long-term. Although weight regain represents a major concern, the real benefit lies in amelioration of comorbidities and quality of life. A5270
COST COMPARISON OF THREE STAPLE-LINE REINFORCEMENT TECHNIQUES IN VERTICAL SLEEVE GASTRECTOMY Marielle VanderVennen, BS, BA1; Tyler Barreto, MD2; Kimberly Kemmeter, RN3; Alan Davis, PhD2; Tracy Koehler, MA2; Paul Kemmeter, MD, FACS3; 1Michigan State University College of Human Medicine, Grand Rapids, MI, USA; 2GRMEP, Grand Rapids, MI, USA; 3Grand Health Partners, Grand Rapids, MI, USA Background: In an era of increasing costs and decreasing reimbursement, providing cost-effective health care is essential. Although various staple-line reinforcement (SLR) techniques have shown potential benefit in reducing complications rates in vertical sleeve gastrectomy (SG), little data are available regarding the costs of these techniques. The purpose of this study was to determine the costs associated with SLR in SG by comparing the use of imbrication (IMB), bovine pericardium (BPC), and polyglycolic acid:trimethylene carbonate (PTC) by assessing product costs and operative time. Thirty day outcomes were also evaluated to assess for effectiveness of the techniques. Methods: A retrospective review was conducted on all patients who underwent a SG from January 1, 2009 to January 1, 2015 by a single group of surgeons. Patients were placed into one of three cohorts based on type of SLR technique (IMB, BPC, or PTC). Data collected included patient demographics, operative time, implant costs, hospital length of stay (LOS), and 30-day postoperative rates of leak, bleed, reoperation, readmission, and mortality. Quantitative data were compared using ANOVA and Tukey’s post-hoc analysis to investigate significant differences. Quantitative data are shown as the meanþSD. Nominal data were compared using the chi-square or Fisher’s Exact test where appropriate and are shown as percentages. Significance was assessed at po0.05. Results: A total of 1,666 patients met inclusion criteria with 445, 345, and 817 patients in the IMB, BPC, and PTC cohorts, respectively. There were no gender differences among the groups (p¼0.728). The PTC group was statistically significantly older than the IMB group (48.7þ13.1 vs. 45.7þ11.6, respectively; po0.001). The pre-op weights for the IMB and PTC groups were significantly different (135.8þ30.4 vs. 130.9þ28.0, respectively; p¼0.02). The IMB group (48.7þ9.1) also had a statistically significant higher BMI than both the BPC (46.7þ8.2; p¼0.007) and PTC groups (47.2þ8.6; p¼0.02). LOS was statistically significantly shorter for the IMB group (2.1þ0.64) compared to the BPC (2.4þ0.92; po0.001) and
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PTC (2.3þ0.75; po0.001) groups. Concerning 30-day complication rates, there were no statistically significant differences between IMB, BPC, and PTC reinforcement types in relation to rates of leak (1.1%, 1.4%, 0.7%, respectively, p¼0.454), bleed (0.4%, 2.3%, 1.1%, respectively, p¼0.116), readmission (2.2%, 4.1%, 2.9%, respectively, p¼0.459), or reoperation (2.1%, 4.3%, 0.5%, respectively, p¼0.186). The average implant cost was $5, $1,254, and $787 for IMB, BPC, and PTC, respectively, with average operative times in minutes of 100, 58, and 85, respectively. Based on an average OR cost of $20/ minute, the overall cost related to SLR techniques were $2,005, $2,414, and $2,487 for IMB, BPC, and PTC, respectively. Conclusions: Although some statistical differences in patient demographics were found among the groups, the clinical relevance is uncertain. More importantly, the safety and efficacy of the techniques were similar as there were no differences related to 30day outcomes. The implant and overall costs related to SLR technique is lowest in the IMB group, but at the expense of increased operative time. Although operative time is lowest in the BPC group, this may be a reflection of individual surgeon speed. A5271
COMPARISON OF STAPLE LINE REINFORCEMENT TECHNIQUE IN VERTICAL SLEEVE GASTRECTOMY PERFORMED BY A SINGLE SURGEON James Polega, BS1; Tyler Barreto, MD2; Kimberly Kemmeter, RN3; Tracy Koehler, MA2; Alan Davis, PhD4; Paul Kemmeter, MD, FACS3; 1Michigan State University College of Human Medicine, Grand Rapids, MI, USA; 2 GRMEP, Grand Rapids, MI, USA; 3Grand Health Partners, Grand Rapids, MI, USA; 4GRMEP, MSU Department of Surgery, Grand Rapids, MI, USA Background: Mechanical stapling devices are widely used resulting in reduced operating time, and reinforcing the staple line has become a common practice in order to reduce the incidence of complications such as bleeding or leaking. Reinforcement techniques vary from staple-line imbrication, over-sewing, or placement of a buttressing material. Numerous studies have compared these different techniques, but typically are limited in size or combine patients from multiple surgeons. In an effort to remove this confounding variable, we have conducted a retrospective cohort study utilizing data from a single surgeon. Methods: The charts of 568 consecutive patients who underwent laparoscopic vertical sleeve gastrectomy (SG) by a single surgeon between January 2008 and August 2014 were reviewed. Three cohorts were created based on the type of staple-line reinforcement utilized, including imbrication (IMBR), polyglycolic acid:trimethylene carbonate (PGA:TMC), or both (BOTH). Data collected were patient demographics, hospital length of stay (LOS), 30-day rates of leak, bleed, readmission, reoperation, and patient mortality. Comparison of quantitative variables between the groups was accomplished via ANOVA. Nominal variables were evaluated using the test or Fisher’s Exact test. Significance was assessed at po0.05. Comparisons of Analysis of Statistical analysis were performed using IBM SPSS Statistics v. 21 (Armonk, NY). Results: Of the 568 charts reviewed, 475 SG were reinforced using IMBR, 42 using PGA:TMC, and 51 using BOTH. Demographic data were similar between IMBR, PGA:TMC, and BOTH in regards to age (45.7 þ/- 11.4, 48.8 þ/- 10.6, and 44.0 þ/- 9.1 years, respectively,
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Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
p¼0.114), weight (136.4 þ/- 30.5, 143.0 þ/- 30.0, and 132.7 þ/27.4 kg, respectively, p¼0.251), and BMI (49.0 þ/- 8.9, 50.2 þ/- 8.2, and 46.4 þ/- 7.1 , respectively, p¼0.076). There was no statistically significant difference between IMBR, PGA:TMC, and BOTH in regards to LOS (2.1 þ/- 0.7, 2.1 þ/- 1.0, and 2.1 þ/- 0.5 days, respectively, p¼0.998), rates of bleed (0.9%, 0%, and 0%, respectively, p40.99), leak (0.7%, 0%, and 0.2%, respectively, p¼0.59), reoperation (0.7%, 0%, and 0.2%, respectively, p¼0.59), and readmission (1.4%, 0%, and 0.2%, respectively, p¼0.8). There was no patient mortality recorded in the entire patient population. Conclusions: Staple-line reinforcement in SG with either imbrication or buttressing with PGA:TMC appears to be equivalent in regards to LOS, 30-day rates of complications, reoperation, readmission, and mortality. There are not any perceived benefits of adding imbrication to the use of PGA:TMC. Choice of reinforcement type should be based on the comfort and skill of the surgeon with each of these techniques. A5272
1000 CONSECUTIVE SLEEVE GASTRECTOMIES IN AN URBAN SAFETY-NET HOSPITAL: ACCREDITATION FACILITATED SAFE EXPANSION OF SURGICAL SERVICES Manish Parikh, MD; Daniel Horwitz, BS; John Saunders, MD; Akuezunkpa Ude Welcome, MD; H Leon Pachter, MD; NYU Medical Center/Bellevue Hospital Center, New York, NY, USA Introduction: Laparoscopic sleeve gastrectomy (LSG) is currently the most common bariatric surgical procedure in the US. It is considered technically simpler to perform than the gastric bypass and is more effective than the gastric band. It is an ideal procedure to implement in an urban safety-net hospital with limited resources. There is also debate regarding “Center of Excellence (COE)” accreditation and potential decreased access to bariatric surgery for under-represented minorities. Methods: A retrospective chart review of the first 1000 LSG at our institution was performed. Our institution is a public hospital that primarily serves under-represented minorities. Patient demographics and surgical outcomes were collected. A repeated measures model was used to create a % excess weight loss (%EWL) model. Outcomes were also compared before vs. after COE accreditation. Results: The cohort was predominantly Hispanic and non-Hispanic African American (96%). The vast majority (475%) were insured publicly or were uninsured (15%). Mean age and BMI were 39 years and 45 kg/m2, respectively. There was an eleven-fold increase in surgical volume after COE accreditation. 1 year %EWL was 64%. 30day readmission and reoperation was 1.5% and 0.4%, respectively. Leak rate was 1.2%. There were no mortalities. Conclusions: The COE model facilitated safe expansion of LSG at an urban safety-net institution. A5273
STAPLE LOAD SELECTION METHOD BASED ON TISSUE THICKNESS MEASUREMENT Leonardo Claros, MD1; Maher ElChaar, MD2; Rose Huang, MS3; George Ezeji, MD1; Jill Stoltzfus, PhD2; 1Allentown, PA, USA; 2 Bethlehem, PA, USA; 3Phoenixville, PA, USA
Background: Current clinical practice for staple cartridge selection is based on experience and perceived tactile feedback. This subjectivity in staple load selection may lead to incomplete staple formation, leakage, or bleeding. The aim of this study is to objectively evaluate the thickness profile of excised specimens and the accuracy of current staple load selection method. Methods: Primary sleeve gastrectomy was performed using either a 36 Fr. ViSiGi 3D™ Calibration System or 36Fr. blunt-tip bougie. The color of each staple load, number of clips, and suturing time to control staple line bleeding was recorded. The double-wall thickness of the excised specimen was measured at three predetermined locations: Antrum, Midbody, and Fundus. The length and weight of each excised specimen were measured. Results: We enrolled 53 patients with a mean age of 45.7 years. BMI averaged 41.2 kg/m2 for men and 41.1 kg/m2 for women. The mean thicknesses at Antrum, Midbody, and Fundus for male patients were 3.02 mm, 2.50 mm, 1.91 mm, respectively. The mean thicknesses for female patients were 2.80 mm, 2.45 mm, and 1.69 mm, respectively. An average of 11.2 clips and 3.7 minutes of suturing time were used to stop staple line bleeding. Conclusion: Selecting the correct staple height may reduce the usage of clips and suture in controlling staple line bleeding. There is a potential need for a laparoscopic tool to accurately and objectively measure the thickness of stomach tissue intraoperatively. A5274
GASTRIC SLEEVE AND FUNDOPLICATION SURGERY IN PATIENTS WITH OBESITY AND GERD Italo Braghetto, MD; Juan Pablo Lasnibat, MD; Luis Gutierrez, MD; Universidad de Chile, Santiago, RM, Chile Introduction: Bariatric surgery in Chile has experienced an exponential increase in recent years, especially the gastric sleeve in patients with a BMI under 35. It's indication is discussed in patients suffering from gastroesophageal reflux disease. Current options are gastric bypass which is not without complications. This study follows a cohort of patients undergoing a novel surgery, which seeks to provide the benefits of both gastric sleeve and antireflux surgery Objectives: To analyze the short- and long-term results with this new surgical technique. Methods: Case series of 15 patients undergoing this surgery at our institution. Clinical records were analyzed and statistical analysis was performed using STATA 11. Results: 14 patients were female. Average age of 46.2 years. The preoperative BMI was 33.9. All patients had alterations in pHmetry and manometry preoperatively. The average operative time was 157 minutes, average hospital stay of 5 days and one minor complication was present in a patient that corresponded to a seroma. There was no perioperative mortality. In the postoperative follow-up, average BMI at 6 months was 27.97, which corresponds to an EWL of 66.71%. All patients showed improvements in pH-metry and manometry at 3 months. During long-term follow-up, 6 patients were re-operated. 4 patients regained weight, one patient regained weight and presented GERD, and one patient only presented GERD. Conclusions: Good results are observed in the short-term followup with reflux resolution in pH-metry and manometry, and loss of
Results: total of 33 patients underwent sleeve gastrectomy at the age of 55 or older. The average age of this patient´s population was 61 (min 55/max 67) years. 91% of all patients could be followed up. The average follow up was 67 months. 1 (3%) complication, namely leakage of the staple line at the gastroesophageal junction, could be observed. %EWL was 45% (min 7.5/max 95). Weight regain of 10kg from the nadir could be seen in 9 (30%) patients. Concerning obesity related comorbidities an amelioration or even remission was reached in 57%. Conclusion: Sleeve gastrectomy in elderly patients can be considered as safe, efficient and reasonable therapy option in the long-term. Although weight regain represents a major concern, the real benefit lies in amelioration of comorbidities and quality of life. A5270
COST COMPARISON OF THREE STAPLE-LINE REINFORCEMENT TECHNIQUES IN VERTICAL SLEEVE GASTRECTOMY Marielle VanderVennen, BS, BA1; Tyler Barreto, MD2; Kimberly Kemmeter, RN3; Alan Davis, PhD2; Tracy Koehler, MA2; Paul Kemmeter, MD, FACS3; 1Michigan State University College of Human Medicine, Grand Rapids, MI, USA; 2GRMEP, Grand Rapids, MI, USA; 3Grand Health Partners, Grand Rapids, MI, USA Background: In an era of increasing costs and decreasing reimbursement, providing cost-effective health care is essential. Although various staple-line reinforcement (SLR) techniques have shown potential benefit in reducing complications rates in vertical sleeve gastrectomy (SG), little data are available regarding the costs of these techniques. The purpose of this study was to determine the costs associated with SLR in SG by comparing the use of imbrication (IMB), bovine pericardium (BPC), and polyglycolic acid:trimethylene carbonate (PTC) by assessing product costs and operative time. Thirty day outcomes were also evaluated to assess for effectiveness of the techniques. Methods: A retrospective review was conducted on all patients who underwent a SG from January 1, 2009 to January 1, 2015 by a single group of surgeons. Patients were placed into one of three cohorts based on type of SLR technique (IMB, BPC, or PTC). Data collected included patient demographics, operative time, implant costs, hospital length of stay (LOS), and 30-day postoperative rates of leak, bleed, reoperation, readmission, and mortality. Quantitative data were compared using ANOVA and Tukey’s post-hoc analysis to investigate significant differences. Quantitative data are shown as the meanþSD. Nominal data were compared using the chi-square or Fisher’s Exact test where appropriate and are shown as percentages. Significance was assessed at po0.05. Results: A total of 1,666 patients met inclusion criteria with 445, 345, and 817 patients in the IMB, BPC, and PTC cohorts, respectively. There were no gender differences among the groups (p¼0.728). The PTC group was statistically significantly older than the IMB group (48.7þ13.1 vs. 45.7þ11.6, respectively; po0.001). The pre-op weights for the IMB and PTC groups were significantly different (135.8þ30.4 vs. 130.9þ28.0, respectively; p¼0.02). The IMB group (48.7þ9.1) also had a statistically significant higher BMI than both the BPC (46.7þ8.2; p¼0.007) and PTC groups (47.2þ8.6; p¼0.02). LOS was statistically significantly shorter for the IMB group (2.1þ0.64) compared to the BPC (2.4þ0.92; po0.001) and
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PTC (2.3þ0.75; po0.001) groups. Concerning 30-day complication rates, there were no statistically significant differences between IMB, BPC, and PTC reinforcement types in relation to rates of leak (1.1%, 1.4%, 0.7%, respectively, p¼0.454), bleed (0.4%, 2.3%, 1.1%, respectively, p¼0.116), readmission (2.2%, 4.1%, 2.9%, respectively, p¼0.459), or reoperation (2.1%, 4.3%, 0.5%, respectively, p¼0.186). The average implant cost was $5, $1,254, and $787 for IMB, BPC, and PTC, respectively, with average operative times in minutes of 100, 58, and 85, respectively. Based on an average OR cost of $20/ minute, the overall cost related to SLR techniques were $2,005, $2,414, and $2,487 for IMB, BPC, and PTC, respectively. Conclusions: Although some statistical differences in patient demographics were found among the groups, the clinical relevance is uncertain. More importantly, the safety and efficacy of the techniques were similar as there were no differences related to 30day outcomes. The implant and overall costs related to SLR technique is lowest in the IMB group, but at the expense of increased operative time. Although operative time is lowest in the BPC group, this may be a reflection of individual surgeon speed. A5271
COMPARISON OF STAPLE LINE REINFORCEMENT TECHNIQUE IN VERTICAL SLEEVE GASTRECTOMY PERFORMED BY A SINGLE SURGEON James Polega, BS1; Tyler Barreto, MD2; Kimberly Kemmeter, RN3; Tracy Koehler, MA2; Alan Davis, PhD4; Paul Kemmeter, MD, FACS3; 1Michigan State University College of Human Medicine, Grand Rapids, MI, USA; 2 GRMEP, Grand Rapids, MI, USA; 3Grand Health Partners, Grand Rapids, MI, USA; 4GRMEP, MSU Department of Surgery, Grand Rapids, MI, USA Background: Mechanical stapling devices are widely used resulting in reduced operating time, and reinforcing the staple line has become a common practice in order to reduce the incidence of complications such as bleeding or leaking. Reinforcement techniques vary from staple-line imbrication, over-sewing, or placement of a buttressing material. Numerous studies have compared these different techniques, but typically are limited in size or combine patients from multiple surgeons. In an effort to remove this confounding variable, we have conducted a retrospective cohort study utilizing data from a single surgeon. Methods: The charts of 568 consecutive patients who underwent laparoscopic vertical sleeve gastrectomy (SG) by a single surgeon between January 2008 and August 2014 were reviewed. Three cohorts were created based on the type of staple-line reinforcement utilized, including imbrication (IMBR), polyglycolic acid:trimethylene carbonate (PGA:TMC), or both (BOTH). Data collected were patient demographics, hospital length of stay (LOS), 30-day rates of leak, bleed, readmission, reoperation, and patient mortality. Comparison of quantitative variables between the groups was accomplished via ANOVA. Nominal variables were evaluated using the test or Fisher’s Exact test. Significance was assessed at po0.05. Comparisons of Analysis of Statistical analysis were performed using IBM SPSS Statistics v. 21 (Armonk, NY). Results: Of the 568 charts reviewed, 475 SG were reinforced using IMBR, 42 using PGA:TMC, and 51 using BOTH. Demographic data were similar between IMBR, PGA:TMC, and BOTH in regards to age (45.7 þ/- 11.4, 48.8 þ/- 10.6, and 44.0 þ/- 9.1 years, respectively,
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Poster Presentations / Surgery for Obesity and Related Diseases 11 (2015) S56–S211
p¼0.114), weight (136.4 þ/- 30.5, 143.0 þ/- 30.0, and 132.7 þ/27.4 kg, respectively, p¼0.251), and BMI (49.0 þ/- 8.9, 50.2 þ/- 8.2, and 46.4 þ/- 7.1 , respectively, p¼0.076). There was no statistically significant difference between IMBR, PGA:TMC, and BOTH in regards to LOS (2.1 þ/- 0.7, 2.1 þ/- 1.0, and 2.1 þ/- 0.5 days, respectively, p¼0.998), rates of bleed (0.9%, 0%, and 0%, respectively, p40.99), leak (0.7%, 0%, and 0.2%, respectively, p¼0.59), reoperation (0.7%, 0%, and 0.2%, respectively, p¼0.59), and readmission (1.4%, 0%, and 0.2%, respectively, p¼0.8). There was no patient mortality recorded in the entire patient population. Conclusions: Staple-line reinforcement in SG with either imbrication or buttressing with PGA:TMC appears to be equivalent in regards to LOS, 30-day rates of complications, reoperation, readmission, and mortality. There are not any perceived benefits of adding imbrication to the use of PGA:TMC. Choice of reinforcement type should be based on the comfort and skill of the surgeon with each of these techniques. A5272
1000 CONSECUTIVE SLEEVE GASTRECTOMIES IN AN URBAN SAFETY-NET HOSPITAL: ACCREDITATION FACILITATED SAFE EXPANSION OF SURGICAL SERVICES Manish Parikh, MD; Daniel Horwitz, BS; John Saunders, MD; Akuezunkpa Ude Welcome, MD; H Leon Pachter, MD; NYU Medical Center/Bellevue Hospital Center, New York, NY, USA Introduction: Laparoscopic sleeve gastrectomy (LSG) is currently the most common bariatric surgical procedure in the US. It is considered technically simpler to perform than the gastric bypass and is more effective than the gastric band. It is an ideal procedure to implement in an urban safety-net hospital with limited resources. There is also debate regarding “Center of Excellence (COE)” accreditation and potential decreased access to bariatric surgery for under-represented minorities. Methods: A retrospective chart review of the first 1000 LSG at our institution was performed. Our institution is a public hospital that primarily serves under-represented minorities. Patient demographics and surgical outcomes were collected. A repeated measures model was used to create a % excess weight loss (%EWL) model. Outcomes were also compared before vs. after COE accreditation. Results: The cohort was predominantly Hispanic and non-Hispanic African American (96%). The vast majority (475%) were insured publicly or were uninsured (15%). Mean age and BMI were 39 years and 45 kg/m2, respectively. There was an eleven-fold increase in surgical volume after COE accreditation. 1 year %EWL was 64%. 30day readmission and reoperation was 1.5% and 0.4%, respectively. Leak rate was 1.2%. There were no mortalities. Conclusions: The COE model facilitated safe expansion of LSG at an urban safety-net institution. A5273
STAPLE LOAD SELECTION METHOD BASED ON TISSUE THICKNESS MEASUREMENT Leonardo Claros, MD1; Maher ElChaar, MD2; Rose Huang, MS3; George Ezeji, MD1; Jill Stoltzfus, PhD2; 1Allentown, PA, USA; 2 Bethlehem, PA, USA; 3Phoenixville, PA, USA
Background: Current clinical practice for staple cartridge selection is based on experience and perceived tactile feedback. This subjectivity in staple load selection may lead to incomplete staple formation, leakage, or bleeding. The aim of this study is to objectively evaluate the thickness profile of excised specimens and the accuracy of current staple load selection method. Methods: Primary sleeve gastrectomy was performed using either a 36 Fr. ViSiGi 3D™ Calibration System or 36Fr. blunt-tip bougie. The color of each staple load, number of clips, and suturing time to control staple line bleeding was recorded. The double-wall thickness of the excised specimen was measured at three predetermined locations: Antrum, Midbody, and Fundus. The length and weight of each excised specimen were measured. Results: We enrolled 53 patients with a mean age of 45.7 years. BMI averaged 41.2 kg/m2 for men and 41.1 kg/m2 for women. The mean thicknesses at Antrum, Midbody, and Fundus for male patients were 3.02 mm, 2.50 mm, 1.91 mm, respectively. The mean thicknesses for female patients were 2.80 mm, 2.45 mm, and 1.69 mm, respectively. An average of 11.2 clips and 3.7 minutes of suturing time were used to stop staple line bleeding. Conclusion: Selecting the correct staple height may reduce the usage of clips and suture in controlling staple line bleeding. There is a potential need for a laparoscopic tool to accurately and objectively measure the thickness of stomach tissue intraoperatively. A5274
GASTRIC SLEEVE AND FUNDOPLICATION SURGERY IN PATIENTS WITH OBESITY AND GERD Italo Braghetto, MD; Juan Pablo Lasnibat, MD; Luis Gutierrez, MD; Universidad de Chile, Santiago, RM, Chile Introduction: Bariatric surgery in Chile has experienced an exponential increase in recent years, especially the gastric sleeve in patients with a BMI under 35. It's indication is discussed in patients suffering from gastroesophageal reflux disease. Current options are gastric bypass which is not without complications. This study follows a cohort of patients undergoing a novel surgery, which seeks to provide the benefits of both gastric sleeve and antireflux surgery Objectives: To analyze the short- and long-term results with this new surgical technique. Methods: Case series of 15 patients undergoing this surgery at our institution. Clinical records were analyzed and statistical analysis was performed using STATA 11. Results: 14 patients were female. Average age of 46.2 years. The preoperative BMI was 33.9. All patients had alterations in pHmetry and manometry preoperatively. The average operative time was 157 minutes, average hospital stay of 5 days and one minor complication was present in a patient that corresponded to a seroma. There was no perioperative mortality. In the postoperative follow-up, average BMI at 6 months was 27.97, which corresponds to an EWL of 66.71%. All patients showed improvements in pH-metry and manometry at 3 months. During long-term follow-up, 6 patients were re-operated. 4 patients regained weight, one patient regained weight and presented GERD, and one patient only presented GERD. Conclusions: Good results are observed in the short-term followup with reflux resolution in pH-metry and manometry, and loss of