To explore the effects of preserving the integrity of gastric antrum and His angle during laparoscopic sleeve gastrectomy (LSG) on postoperative gastroesophageal reflux disease (GERD) and clinical outcomes.

A total of 156 patients with GERD after LSG admitted from January 2024 to April 2025 were enrolled and randomly divided into observation group and control group by random number table, with 78 cases in each group. Patients in the observation group underwent modified LSG with intact gastric antrum and His angle preserved, while the control group received conventional LSG. T test and chi-square test were adopted to compare major clinical outcome indicators, weight loss efficacy and nutritional parameters between the two groups before operation and 6 months postoperatively. A P value less than 0.05 was considered statistically significant.

At 6 months after surgery, the GERD questionnaire score, Los Angeles classification of esophagitis and DeMeester score in the observation group were markedly lower, whereas the quality of life score was obviously higher than those in the control group (P<0.05). No significant differences were observed in percentage total weight loss (%TWL), percentage excess weight loss (%EWL), body mass index (BMI), ferritin, vitamin B12, 25-hydroxyvitamin D, glycated hemoglobin, fasting blood glucose and triglyceride between the two groups (P>0.05). The operative duration was significantly longer in the observation group (P<0.05), while estimated intraoperative blood loss and conversion rate to open surgery showed no statistical differences (P>0.05). The incidence of postoperative complications was comparable between the two groups (P>0.05).

The modified LSG preserving intact gastric antrum and His angle can effectively reduce the risk of postoperative GERD and improve patients' quality of life, without affecting the core curative effects on weight loss, nutrition and metabolism.