Laparoscopic Sleeve-Fundoplication for Morbidly Obese Patients with Gastroesophageal Reflux: Systematic Review and Meta-analysis

Abstract

Introduction Laparoscopic sleeve gastrectomy (LSG) has rapidly become popular with excellent results. However, LSG may exacerbate or increase the risk of “de novo” gastroesophageal reflux disease (GERD). Adding a fundoplication has been proposed to increase the lower esophageal sphincter competency. The aim of this study was to examine the current evidence and outcomes of sleeve-fundoplication (Sleeve-F). Materials and Methods Systematic review and meta-analysis. Web of Science, PubMed, and Embase data sets were consulted. Results Six studies (485 patients) met the inclusion criteria. The age of the patient population ranged from 17 to 72 years old and 82% were females. All patients underwent sleeve-fundoplication. Rossetti, Collis-Nissen, and Nissen were the most commonly performed fundoplications. The estimated pooled prevalence of postoperative leak, gastric perforation, and overall complications were 1.0% (95% CI = 0.0–2.0%), 2.9% (95% CI = 0.0–8.3%), and 9.8% (95% CI = 6.7–13.4%), respectively. The pooled reoperation rate was 4.1% (95% CI = 1.3–10%). There was no mortality. At 12-month follow-up, the estimated pooled BMI and %EWL were 29.9 kg/m2 (95% CI = 28.5–31.2) and 66.2% (95% CI = 59.3–71.1), respectively, while esophagitis, PPI consumption, and GERD rates were 8.0% (95% CI 3–21%), 7.8% (95% CI 5–13%), and 11% (95% CI 4–26%). Conclusions This systematic review and meta-analysis shows that current evidence for Sleeve-F is limited with high postoperative gastric perforation and overall complication rates. Weight loss and GERD resolution seem promising in the short term; however, further studies are warranted to explore long-term effects with instrumental investigations. Sleeve-F should be considered cautiously while future well-structured randomized trials are warranted.

Gastroesophageal reflux related changes after sleeve gastrectomy and sleeve gastrectomy with fundoplication: A retrospective single center study

“…In a metaanalysis, Oor et al (20) reviewed 33 studies, of which 30 studies reported the effect of LSG on the prevalence of GERD symptoms, 12 reported a decrease in the postoperative prevalence of GERD symptoms, and a total of 24 studies reported the incidence of new-onset GERD symptoms, The incidence of de novo GERD following LSG can be up to 35% and new-onset esophagitis ranged from 6.3% to 63.3%.These series have raised significant concern and debate around the effect of LSG on GERD. The contributive factors to GERD include a decrease in low esophageal sphincter(LES) pressure ( 21), esophageal motility dysfunction, injury to the anti-reflux barrier (disruption of the angle of His and division of sling fibers) (22), increased number of transient LES relaxations, reduction in the compliance of the gastric (5), and increased gastric pressure (23). There are still concerns regarding the real effects of LSG on GERD, while Rouxen-Y gastric bypass has demonstrated a postoperative reduction of GERD.…”

Nissen-Sleeve procedure versus laparoscopic Roux-en-Y gastric bypass in patients with morbid obesity and gastro-oesophageal reflux disease: protocol for a non-inferiority randomised trial (GINSBY)

“…In 12.7% of all patients, the 24-hour pH monitoring was positive although they did not have GORD 37. Therefore, the Montreal definition is used for inclusion, as it is a non-invasive and globally well-accepted consensus to define GORD 12 13 34 36 38. To objectify and quantify GORD, we will use the validated GORD-Q questionnaire and endoscopy at baseline and during FU 19 39.…”

The Hill’s Classification Is Useful to Predict the Development of Postoperative Gastroesophageal Reflux Disease and Erosive Esophagitis After Laparoscopic Sleeve Gastrectomy

“…More studies are needed to determine the ideal surgical technique for such patients predisposed to GERD and EE after LSG. Initial results for concomitant LSGfundoplication were associated with increased complication rates [27]. The authors also eagerly await the results of the RELIEF trial, which investigated the role of LINX TM magnetic sphincter augmentation in patients with postoperative GERD after LSG, that has recently nished recruitment (ClinicaTrials.gov Identifer: NCT02429830).…”