Robotic-assisted approaches to GERD following sleeve gastrectomy



Sleeve gastrectomy (SG) is the most common bariatric operation in the United States but increases the incidence of gastroesophageal reflux disease (GERD). The aim of our study was to describe our experience with robotic-assisted management of intractable GERD after SG.


A systematic review of a prospectively maintained database was performed of consecutive patients undergoing robotic-assisted magnetic sphincter augmentation placement after sleeve gastrectomy (MSA-S group) or conversion to Roux-en-Y gastric bypass (RYGB group) for GERD from 2015 to 2019 at our tertiary- care bariatric center. These were compared to a consecutive group of patients undergoing robotic-assisted magnetic sphincter augmentation placement (MSA group) for GERD without a history of bariatric surgery from 2016 to 2019. The primary outcome was perioperative morbidity. Secondary outcomes were operative time (OT), 90-day re-intervention rate, length of stay, symptom resolution and weight change.


There were 51 patients included in this study; 18 patients in the MSA group, 13 patients in the MSA-S group, and 20 patients in the RYGB group. There was no significant difference in age, gender, ASA score, preoperative endoscopic findings, or DeMeester scores (P > 0.05). BMI was significantly higher in patients undergoing RYGB compared to MSA or MSA-S (P < 0.0001). There were significant differences in OT between the MSA and RYGB groups (P < 0.0001) and MSA-S and RYGB groups (P = 0.009), but not MSA group to MSA-S group (P = 0.51). There was no significant difference in intraoperative and postoperative morbidity (P = 1.0 and P = 0.60, respectively). 30-day morbidity: 5.6% (MSA), 15.4% (MSA-S) and 15% (RYGB). There was no difference on PPI discontinuation among groups, with more than 80% success rate in all.


The use of the robotic platform in the different approaches available for treatment of GERD after SG appears to be a feasible option with low morbidity and high success rate. Further data is needed to support our findings.

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  1. 1.

    Chaar ME, Lundberg P, Stoltzfus J (2018) Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass: first report based on Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis 14(5):545–551

    Article  Google Scholar 

  2. 2.

    Abelson JS, Afaneh C, Dolan P, Chartrand G, Dakin G, Pomp A (2016) Laparoscopic sleeve gastrectomy: co-morbidity profiles and intermediate-term outcomes. Obes Surg 26(8):1788–1793

    Article  Google Scholar 

  3. 3.

    Gray KD, Moore MD, Bellorin O et al (2018) Increased metabolic benefit for obese, elderly patients undergoing Roux-en-Y gastric bypass vs sleeve gastrectomy. Obes Surg 28(3):636–642

    Article  Google Scholar 

  4. 4.

    Salminen P, Helmio M, Ovaska J et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial. JAMA 319(3):241–254

    Article  Google Scholar 

  5. 5.

    DuPree CE, Blair K, Steele SR, Martin MJ (2014) Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg 149(4):328–334

    Article  Google Scholar 

  6. 6.

    Felsenreich DM, Kefurt R, Schermann M et al (2017) Reflux, sleeve dilation, and Barrett's esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg 27(12):3092–3101

    Article  Google Scholar 

  7. 7.

    Genco A, Soricelli E, Casella G et al (2017) Gastroesophageal reflux disease and Barrett's esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis 13(4):568–574

    Article  Google Scholar 

  8. 8.

    Soong TC, Almalki OM, Lee WJ, Ser KH, Chen JC, Wu CC, Chen SC (2019) Revision of sleeve gastrectomy with hiatal repair with gastropexy for gastroesophageal reflux disease. Obes Surg 29(8):2381–2386.

    Article  PubMed  Google Scholar 

  9. 9.

    Hawasli A, Bush A, Hare B et al (2015) Laparoscopic management of severe reflux after sleeve gastrectomy, in selected patients, without conversion to Roux-en-Y gastric bypass. J Laparoendosc Adv Surg Technol 25:631–635

    Article  Google Scholar 

  10. 10.

    Elmously A, Gray KD, Ullmann TM, Fahey TJ 3rd, Afaneh C, Zarnegar R (2018) Robotic reoperative anti-reflux surgery: low perioperative morbidity and high symptom resolution. World J Surg 42(12):4014–4021

    Article  Google Scholar 

  11. 11.

    Gray KD, Moore MD, Elmously A et al (2018) Perioperative outcomes of laparoscopic and robotic revisional bariatric surgery in a complex patient population. Obes Surg 28(7):1852–1859

    Article  Google Scholar 

  12. 12.

    Tolboom RC, Draaisma WA, Broeders IA (2016) Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study. J Robot Surg 10(1):33–39

    Article  Google Scholar 

  13. 13.

    Afaneh C, Zoghbi V, Finnerty BM, Aronova A, Kleiman D, Ciecierega T, Crawford C, Fahey TJ 3rd, Zarnegar R (2016) BRAVO esophageal pH monitoring: more cost-effective than empiric medical therapy for suspected gastroesophageal reflux. Surg Endosc 30(8):3454–3460

    Article  Google Scholar 

  14. 14.

    Gray KD, Moore MD, Elmously A, Bellorin O, Zarnegar R, Dakin G, Pomp A, Afaneh C (2018) Perioperative outcomes of laparoscopic and robotic revisional bariatric surgery in a complex patient population. Obes Surg 28(7):1852–1859

    Article  Google Scholar 

  15. 15.

    Casillas RA, Um SS, Zelada Getty JL, Sachs S, Kim BB (2016) Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center. Surg Obes Relat Dis 12(10):1817–1825

    Article  Google Scholar 

  16. 16.

    Iannelli A, Debs T, Martini F, Benichou B, Ben Amor I, Gugenheim J (2016) Laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: indications and preliminary results. Surg Obes Relat Dis 12(8):1533–1538

    Article  Google Scholar 

  17. 17.

    Langer FB, Bohdjalian A, Shakeri-Leidenmuhler S, Schoppmann SF, Zacherl J, Prager G (2010) Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass—indications and outcome. Obes Surg 20(7):835–840

    Article  Google Scholar 

  18. 18.

    Bonavina L, Saino GI, Bona D et al (2008) Magnetic augmentation of the lower esophageal sphincter: results of a feasibility clinical trial. J Gastrointest Surg 12(12):2133–2140

    Article  Google Scholar 

  19. 19.

    Lipham JC, Taiganides PA, Louie BE, Ganz RA, DeMeester TR (2015) Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus 28(4):305–311

    CAS  Article  Google Scholar 

  20. 20.

    Ganz RA, Peters JH, Horgan S et al (2013) Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med 368(8):719–727

    CAS  Article  Google Scholar 

  21. 21.

    Bonavina L, DeMeester T, Fockens P et al (2010) Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure: one- and 2-year results of a feasibility trial. Ann Surg 252(5):857–862

    Article  Google Scholar 

  22. 22.

    Bonavina L, Saino G, Bona D, Sironi A, Lazzari V (2013) One hundred consecutive patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease: 6 years of clinical experience from a single center. J Am Coll Surg 217(4):577–585

    Article  Google Scholar 

  23. 23.

    Warren HF, Reynolds JL, Lipham JC et al (2016) Multi-institutional outcomes using magnetic sphincter augmentation versus Nissen fundoplication for chronic gastroesophageal reflux disease. Surg Endosc 30(8):3289–3296

    Article  Google Scholar 

  24. 24.

    Desart K, Rossidis G, Michel M, Lux T, Ben-David K (2015) Gastroesophageal reflux management with the LINX(R) system for gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. J Gastrointest Surg 19(10):1782–1786

    Article  Google Scholar 

  25. 25.

    Bruzzi M, Voron T, Zinzindohoue F, Berger A, Douard R, Chevallier JM (2016) Revisional single-anastomosis gastric bypass for a failed restrictive procedure: 5-year results. Surg Obes Relat Dis 12(2):240–245

    Article  Google Scholar 

  26. 26.

    Almalki OM, Lee WJ, Chen JC, Ser KH, Lee YC, Chen SC (2018) Revisional gastric bypass for failed restrictive procedures: comparison of single-anastomosis (Mini-) and Roux-en-Y Gastric bypass. Obes Surg 28(4):970–975

    Article  Google Scholar 

  27. 27.

    Kuckelman JP, Phillips CJ, Derickson MJ, Faler BJ, Martin MJ (2018) Esophageal magnetic sphincter augmentation as a Novel approach to post-bariatric surgery gastroesophageal reflux disease. Obes Surg 28(10):3080–3086

    Article  Google Scholar 

  28. 28.

    Singhal S, Kirkpatrick DR, Masuda T, Gerhardt J, Mittal SK (2018) Primary and redo antireflux surgery: outcomes and lessons learned. J Gastrointest Surg 22(2):177–186

    Article  Google Scholar 

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This study was internally funded.

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Correspondence to Cheguevara Afaneh.

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Dr. Afaneh reports honoraria from Intuitive Surgical, outside the submitted work. Drs. Bellorin, Dolan, Vigiola-Cruz, Al Hussein, Pomp, & Dakin have no conflicts of interest or financial ties to disclose.

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Bellorin, O., Dolan, P., Vigiola-Cruz, M. et al. Robotic-assisted approaches to GERD following sleeve gastrectomy. Surg Endosc (2020).

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  • GERD
  • Bariatrics
  • Robotics
  • Sleeve
  • Bypass