Ligamentum Teres Cardiopexy in Treatment of GERD After Sleeve Gastrectomy

Inclusion Criteria: * • patients who previously underwent laparoscopic sleeve gastrectomy * Adequate anatomy to perform the procedure For example, ability to mobilize adequate intra-abdominal esophagus (e.g. freeing 3-5 cm of esophagus into abdomen) and enough ligamentum teres tissue to wrap/fix * Patients experiencing GERD symptoms refractory to medical therapy (e.g., proton pump inhibitors more than 8 weeks ) Exclusion Criteria: * • Known esophageal motility disorders (achalasia, scleroderma). * Barrett's esophagus with high grade dysplasia * Presence of complications contraindicating the use of ligamentum teres For example, prior surgeries that compromised ligamentum teres, hepatic disease, malignancy near ligament region