VIDEO SUBMISSION Treating Severe GERD and Obesity with a Sleeve Gastrectomy with Cardioplication and a Transit Bipartition Sergio Santoro 1 & Filippe Camarotto Mota 1 & Caio Gustavo Aquino 1 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Introduction Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastro- esophageal reflux disease (GERD). The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30. Although still controversial in the literature, there are several studies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The current video shows the technique of a SG with cardioplication associated with transit bipartition (TB) for the treatment of an obese patient with severe GERD. Case Report and Management A 46-year-old male presented with obesity and GERD symptoms for several years. His BMI was 37.8 kg/m 2 with mainly central obesity and several obesity-related comorbidities, including hypertension, dyslipidemia, severe insulin resistance, and obstructive sleep apnea. After a diagnostic evaluation, the patient was submitted to a sleeve gastrectomy with a transit bipartition. He presented satisfactory weight loss, reaching a BMI of 26 and remission of all comorbidities and complete remission of GERD symptoms. The current follow-up period is 2.5 years and the patient did not present any weight regain or return of the GERD symptoms. Conclusion We presented a surgical alternative that is effective in both weight loss and remission of GERD. SG + TB is a potent intervention for metabolic syndrome and obesity. Furthermore, this alternative is capable of treating both obesity and GERD, in a simple way, avoiding mechanical restriction and the significant malabsorption related to excluded segments. Keywords Morbidity obesity . GERD . Bariatric surgery . Sleeve gastrectomy . Transit bipartition Introduction Obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD) [1]. The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30 [2]. Several physiologic abnormalities link these two disorders, as hypotensive lower esophageal sphincter (LES) pressure [3], higher frequency of transient relaxations of the lower esophageal sphincter (TRLES) [4], higher prev- alence of hiatal hernia [5], and an increased intra-abdominal pressure [6]. Although still controversial in the literature, there are stud- ies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The hypotension of the LES after the dis- ruption of the sling fibers [7] and the increased gastric pressure [8] after the SG are some of the proposed mechanisms for increased GERD after SG. In 2007, we published the first experiences with SG and anti-reflux gastroesophageal plications [9, 10]. The current video shows the technique of a SG with cardioplication asso- ciated with transit bipartition (TB) [11] for the treatment of an obese patient with severe GERD. Case Report and Management A 46-year-old male presented with obesity and GERD symp- toms for several years. His main complaints were heartburn after eating and regurgitation of food when lying down after a meal. His BMI was 37.8 kg/m 2 with mainly central obesity and several obesity-related comorbidities, including Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-019-03752-4) contains supplementary material, which is available to authorized users. * Filippe Camarotto Mota ficamarotto@gmail.com 1 Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP 050652-900, Brazil Obesity Surgery https://doi.org/10.1007/s11695-019-03752-4