A Study to Reduce the Reflux After a Sleeve Gastrectomy in Obese Patients

NCT ID: NCT04287972

Last Updated: 2022-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-08

Study Completion Date

2022-10-31

Brief Summary

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This is a monocentric randomized controlled prospective study. A total of 122 patients will be recruited and randomized 1: 1 in the experimental group - Laparoscopic Sleeve Gastrectomy and Diaphragmatic Pillar Closure - or in the control group - Laparoscopic Sleeve Gastrectomy.

At 6 months post surgery a gastroscopy, an oesophageal manometry and a PH-study will be perform to detect de novo GastroEsophageal Reflux Disease and hiatal hernia appearance.

Detailed Description

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Conditions

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Gastroesophageal Reflux Obesity

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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LSG-DPC

Laparoscopic Sleeve Gastrectomy and Diaphragmatic Pillar Closure.

Group Type EXPERIMENTAL

DPC

Intervention Type PROCEDURE

The anterior fat pad is dissected until the left crura is visible, pars flaccida is open and the right crura exposed. Phreno-oesophageal ligament is sectioned starting from the right crura. Posterior and anterior vagal nerve are recognized before the oesophageal dissection. An intra-abdominal oesophagus lengths of 2 or 3 cm is obtained in order to reduce tension. Left and right crura are sutured with 2 or 3 non absorbable 2-0 stitches; an additional anterior stitch is posed if necessary to calibrate hiatus size without oesophageal deviation.

LSG

Intervention Type PROCEDURE

After omental section close to gastric insertion, gastric stapling is realised with triple line endo stapler (normally 5 or 6 re-loads). The gastrectomy begins 5-6 cm from the pylorus; gastric fundus is totally resected keeping a distance of 5-10 mm from oesophagus. Any bleeding on staple line is controlled with surgical clips or coagulator.

LSG

Laparoscopic Sleeve Gastrectomy

Group Type ACTIVE_COMPARATOR

LSG

Intervention Type PROCEDURE

After omental section close to gastric insertion, gastric stapling is realised with triple line endo stapler (normally 5 or 6 re-loads). The gastrectomy begins 5-6 cm from the pylorus; gastric fundus is totally resected keeping a distance of 5-10 mm from oesophagus. Any bleeding on staple line is controlled with surgical clips or coagulator.

Interventions

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DPC

The anterior fat pad is dissected until the left crura is visible, pars flaccida is open and the right crura exposed. Phreno-oesophageal ligament is sectioned starting from the right crura. Posterior and anterior vagal nerve are recognized before the oesophageal dissection. An intra-abdominal oesophagus lengths of 2 or 3 cm is obtained in order to reduce tension. Left and right crura are sutured with 2 or 3 non absorbable 2-0 stitches; an additional anterior stitch is posed if necessary to calibrate hiatus size without oesophageal deviation.

Intervention Type PROCEDURE

LSG

After omental section close to gastric insertion, gastric stapling is realised with triple line endo stapler (normally 5 or 6 re-loads). The gastrectomy begins 5-6 cm from the pylorus; gastric fundus is totally resected keeping a distance of 5-10 mm from oesophagus. Any bleeding on staple line is controlled with surgical clips or coagulator.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age between 18-65 years
* Patient with BMI between 35 and 50 Kg/m2 for whom laparoscopic sleeve gastrectomy indication was made
* Patients with no preoperative gastroesophageal reflux disease symptoms
* Hill 2-3 or 4 (with HH \<2 cm) hypogastric valve diagnosed preoperatively

Exclusion Criteria

* Gastroesophageal reflux disease with daily symptoms or daily use of proton pump inhibitors drugs or daily use of anti-H2 drugs
* Hiatal Hernia \>2cm and/or esophagitis and/or Barrett metaplasia
* Previous bariatric and/or gastric surgery
* Normal gastroesophageal valve (Hill 1)
* Motility disorders of the esophagus (documented on manometry)
* PH-study positive for gastro-oesophageal reflux disease (DeMeester Score \>14.1)
* Contraindications to gastroscopy or manometry or ph-study
* Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant
* Patient not legally competent
* Pregnancy
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fabio Garofalo

OTHER

Sponsor Role lead

Responsible Party

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Fabio Garofalo

Sponsor Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Fabio Garofalo

Role: PRINCIPAL_INVESTIGATOR

EOC

Locations

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Ospedale Regionale di Lugano, Civico e Italiano

Lugano, , Switzerland

Site Status

Countries

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Switzerland

Other Identifiers

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ORL-CHIR-003

Identifier Type: -

Identifier Source: org_study_id

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