Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 2 Date: 25 May 2025
Reviewer:  Mohamed Ibrahim
Reviewer's report:
• This study examines the effectiveness of Laparoscopic Sleeve Gastrectomy with His angle
reconstruction in comparison to conventional LSG in mitigating postoperative Gastroesophageal
Reflux Disease and enhancing weight loss. Although the subject is pertinent, several
methodological shortcomings limit the reliability and broader applicability of the results.
• GERD symptom evaluation is based solely on subjective questionnaires (RD-Q and GERD-Q),
without incorporating objective diagnostic tools such as 24-hour pH monitoring or esophageal
manometry. Relying on subjective measures introduces potential bias and may not accurately
capture the physiological changes following surgery.
• The lack of intraoperative photographs represents a significant limitation. Visual
documentation would offer clearer insights into the specific surgical steps of the LSG-His
technique, particularly regarding suture placement and the extent of angle reconstruction. In
the absence of such images, evaluating the precision and consistency of the procedure across
patients becomes challenging.
• The study notes that patients chose their surgical procedure voluntarily, which introduces
potential selection bias. Individuals opting for LSG-His may differ in their baseline
characteristics or expectations compared to those selecting standard LSG, potentially
influencing the outcomes.
• The study does not sufficiently address selection bias. Notably, GERD morbidity appears to be
the most influential factor affecting sample size, further limiting the robustness of the findings.
• Consequently, the study’s conclusions should be interpreted with caution. Future research
should involve well-designed, multi-center randomized controlled trials with objective GERD
assessments and extended follow-up periods to validate the findings.
Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 2 Date: 25 May 2025
Reviewer:  Mohamed Ibrahim
Reviewer's report:
• This study examines the effectiveness of Laparoscopic Sleeve Gastrectomy with His angle
reconstruction in comparison to conventional LSG in mitigating postoperative Gastroesophageal
Reflux Disease and enhancing weight loss. Although the subject is pertinent, several
methodological shortcomings limit the reliability and broader applicability of the results.
• GERD symptom evaluation is based solely on subjective questionnaires (RD-Q and GERD-Q),
without incorporating objective diagnostic tools such as 24-hour pH monitoring or esophageal
manometry. Relying on subjective measures introduces potential bias and may not accurately
capture the physiological changes following surgery.
• The lack of intraoperative photographs represents a significant limitation. Visual
documentation would offer clearer insights into the specific surgical steps of the LSG-His
technique, particularly regarding suture placement and the extent of angle reconstruction. In
the absence of such images, evaluating the precision and consistency of the procedure across
patients becomes challenging.
• The study notes that patients chose their surgical procedure voluntarily, which introduces
potential selection bias. Individuals opting for LSG-His may differ in their baseline
characteristics or expectations compared to those selecting standard LSG, potentially
influencing the outcomes.
• The study does not sufficiently address selection bias. Notably, GERD morbidity appears to be
the most influential factor affecting sample size, further limiting the robustness of the findings.
• Consequently, the study’s conclusions should be interpreted with caution. Future research
should involve well-designed, multi-center randomized controlled trials with objective GERD
assessments and extended follow-up periods to validate the findings.
Please review this paper.
user
Title: The Short-term Effect of Laparoscopic Sleeve Gastrectomy with His Angle
Reconstruction (LSG-His) on Gastroesophageal Reflux Disease
Version: 2 Date: 25 May 2025
Reviewer:  Mohamed Ibrahim
Reviewer's report:
• This study examines the effectiveness of Laparoscopic Sleeve Gastrectomy with His angle
reconstruction in comparison to conventional LSG in mitigating postoperative Gastroesophageal
Reflux Disease and enhancing weight loss. Although the subject is pertinent, several
methodological shortcomings limit the reliability and broader applicability of the results.
• GERD symptom evaluation is based solely on subjective questionnaires (RD-Q and GERD-Q),
without incorporating objective diagnostic tools such as 24-hour pH monitoring or esophageal
manometry. Relying on subjective measures introduces potential bias and may not accurately
capture the physiological changes following surgery.
• The lack of intraoperative photographs represents a significant limitation. Visual
documentation would offer clearer insights into the specific surgical steps of the LSG-His
technique, particularly regarding suture placement and the extent of angle reconstruction. In
the absence of such images, evaluating the precision and consistency of the procedure across
patients becomes challenging.
• The study notes that patients chose their surgical procedure voluntarily, which introduces
potential selection bias. Individuals opting for LSG-His may differ in their baseline
characteristics or expectations compared to those selecting standard LSG, potentially
influencing the outcomes.
• The study does not sufficiently address selection bias. Notably, GERD morbidity appears to be
the most influential factor affecting sample size, further limiting the robustness of the findings.
• Consequently, the study’s conclusions should be interpreted with caution. Future research
should involve well-designed, multi-center randomized controlled trials with objective GERD
assessments and extended follow-up periods to validate the findings.
assistant