Case ReportLaparoscopic management of severe reflux after sleeve gastrectomy using the LINX® system: Technique and one year follow up case report

•Prevalence of reflux after sleeve gastrectomy.•Introduction of new device to treat reflux after sleeve gastrectomy.•The use of LINX system in treating reflux after sleeve gastrectomy.

IntroductionManagement of severe reflux after sleeve gastrectomy (SG) usually requires converting to Roux-en-y gastric bypass (RYGB). We present a case of managing this problem using the LINX® system.Presentation of caseIn February 2015, we performed a laparoscopic placement of LINX® system to treat severe reflux after sleeve gastrectomy on a 25-year-old female. The operative time was 47 min. There were no intra or postoperative complications. The hospital stay was one day. The postoperative UGI showed no reflux. Ten days after surgery her Quality of life score (QOL) changed from 64/75 to 7/75 after the LINX® placement. One year later the patient continued to enjoy no reflux and stayed off medication.DiscussionReflux after sleeve gastrectomy is usually managed by conversion to RYGB by most surgeons. This case report opens the door for an alternative management of this problem while maintaining the original sleeve gastrectomy. This technique is reasonably easy to perform in comparison to the conversion to RYGB with less potential post-operative complications. A one year follow up showed good control of reflux without medication.ConclusionLaparoscopic placement of the LINX® system to correct severe reflux after sleeve gastrectomy is a safe alternative procedure to conversion to a RYGB.