Impact of Ligamentum Teres Cardiopexy during Laparoscopic Sleeve Gastrectomy on early Intrathoracic Sleeve Migration: A prospective Cohort Study.

Abstract

Background: Intrathoracic sleeve migration is a recognized complication after laparoscopic sleeve gastrectomy (LSG) and is frequently associated with postoperative gastroesophageal reflux disease (GERD). Ligamentum teres cardiopexy (LTC) has been proposed as a technique to stabilize the gastroesophageal junction and reduce postoperative sleeve migration.

Objective: To evaluate the effect of adding ligamentum teres cardiopexy to laparoscopic sleeve gastrectomy on preventing early intrathoracic sleeve migration and improving reflux-related outcomes.

Methods: This prospective cohort study included 40 patients undergoing primary laparoscopic sleeve gastrectomy between April 2024 and April 2025. Twenty patients underwent LSG with ligamentum teres cardiopexy (LSG+LTC), while 20 underwent standard LSG alone. Outcomes assessed at one year included GERD-Health Related Quality of Life (GERD-HRQL) scores, upper gastrointestinal endoscopic Hill's grade, gastric CT volumetry (hernial sac volume and hiatal defect area), operative time, and postoperative complications.

Results: Baseline demographic and clinical characteristics were comparable between the two groups. The LSG+LTC group demonstrated significantly lower postoperative symptom severity than the LSG group (16.3 ± 5.9 vs. 22.2 ± 7.8; p = 0.010). Progression of Hill's grade was significantly less frequent in the LSG+LTC group, with postoperative grade III observed in 5% versus 30% of patients (p = 0.038). Patients with LSG+LTC were also more likely to achieve a GERD-HRQL score ≤12 (25% vs. 0%; p = 0.047). Although postoperative hernial sac volume (21.9 ± 10.1 vs. 27.4 ± 11.3 mL; p = 0.109) and hiatal defect area (3.7 ± 0.5 vs. 4.0 ± 0.5 cm²; p = 0.091) were lower in the LSG+LTC group, these differences were not statistically significant. Operative time was significantly longer with LTC (89.7 ± 8.9 vs. 78.9 ± 9.7 minutes; p < 0.001). Postoperative complication rates were comparable between groups.

Conclusion: Ligamentum teres cardiopexy performed during laparoscopic sleeve gastrectomy significantly improved postoperative reflux symptoms and endoscopic findings without increasing postoperative complications. Although radiological measures of intrathoracic sleeve migration did not differ significantly, LTC appears to be a safe adjunctive procedure that may improve functional outcomes after sleeve gastrectomy. Larger multicenter studies with longer follow-up are warranted to confirm these findings.