Objective To evaluate the impact of preserving versus resecting the angle of His fat pad at the gastroesophageal junction (abbreviated as “fat pad”) during laparoscopic sleeve gastrectomy (LSG) on the incidence of postoperative gastroesophageal reflux disease (GERD) and weight loss outcomes. Methods Consecutive obese patients who underwent LSG at the Third People’s Hospital of Chengdu from January 2018 to February 2023 were enrolled. Based on whether the fat pad was resected during surgery, the patients were divided into a group with preservation of the fat pad (preservation group) and group with resection of fat pad (resection group). The primary outcome was the incidence of GERD at 1 year postoperatively. Secondary outcomes were weight loss effects, evaluated by the percentage of excess weight loss (EWL%) and the percentage of total weight loss (TWL%). Furthermore, a subgroup analysis was conducted within the preservation group based on the distance of the stapler from the fat pad (0.5 cm, 1.0 cm, 2.0 cm). After adjusting for confounding factors using multivariate logistic regression and linear regression models, the association between fat pad resection and the incidence of postoperative GERD, as well as EWL% and TWL%, was analyzed. Results A total of 560 obese patients were enrolled in this study, with 395 in the preservation group and 165 in the resection group. The incidence of postoperative GERD was significantly lower in the preservation group than in the resection group [25.32% (100/395) vs. 41.82% (69/165), P<0.001]. After adjusting for confounding factors (age, sex, body mass index, cholesterol, fasting blood glucose, and hemoglobin A1c), preservation of the fat pad might be an independent protective factor against postoperative GERD [OR (95%CI)=0.41 (0.25, 0.67), P<0.001]. Regarding weight loss outcomes, preservation of the fat pad had no significant effect on EWL% [β (95%CI)=–4.79 (–16.25, 6.66), P=0.41], but had a significant effect on TWL% [β (95%CI) =–3.27 (–5.45, –1.10), P=0.003]. Within the preservation group, subgroup comparisons (0.5 cm, 1.0 cm, and 2.0 cm) showed no statistically significant differences in the incidence of postoperative GERD (P=0.71), EWL% (P=0.93), or TWL% (P=0.15). Conclusions For LSG, resection of the fat pad may increase the risk of postoperative GERD but could be associated with better TWL%. Under the premise of preserving the fat pad, the distance of the stapler from the fat pad (0.5–2.0 cm) has no significant impact on the incidence of postoperative GERD or weight loss outcomes.
Citation：
GUO Mingjie, YANG Huawu, WANG Haibo, WANG Bing, XU Sunpeng, ZHU Hongmei, LIU Yanjun. Effect of preserving angle of His fat pad at gastroesophageal junction on anti-reflux efficacy and weight loss outcomes following laparoscopic sleeve gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(4): 528-532. doi: 10.7507/1007-9424.202601033
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