Background

De novo gastroesophageal reflux disease status post sleeve gastrectomy is a common problem that bariatric surgeons face. This is due to a variety of factors including presence of hiatal hernia, increased pressure within the gastric sleeve and decreased gastric motility. Given surgically altered anatomy, traditional anti reflux procedures including fundoplication are not an option. Conversion to Roux-en-Y gastric bypass, while an effective treatment of GERD is associated with many known long term complications and is often not desirable for patients. We have proposed the technique of ligament teres fundoplication as a means for surgical treatment of de-novo GERD in patients status post sleeve gastrectomy. As seen in the presented video abstract, the ligamentum teres is dissected free from the anterior abdominal wall preserving as much length as possible. Any hiatal defect is repaired. The ligamentum is used to wrap in a posterior 270 degree 'Shepherd's hook' fashion and sutured to the right crus and anterior sleeve. This allows for a durable surgical treatment for GERD as well as salvage of sleeve gastrectomy and minimal long term complications.