The Nissen-Sleeve (N-Sleeve): Results of a Cohort Study

Amor, Imed Ben; Casanova, Vincent; Vanbiervliet, Geoffroy; Bereder, Jean Marc; Habitan, Richard; Kassir, Radwan; Gugenheim, Jean

doi:10.1007/s11695-020-04469-5

Cited by 35 publications

(17 citation statements)

References 27 publications

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“…Our current review confirmed this hypothesis as the leak from the staple line has a lower frequency, described only in three patients (0.6%) [14,15,17] compared to perforation of the valve described in 15 cases (3.1%) [13,16]. In these cases, the authors recommended laparoscopic revision with resection of the gastric valve, perigastric abscess drainage, and conversion to a standard LSG in the majority of cases.…”

Section: Discussionsupporting

confidence: 73%

“…Considering all these findings, several bariatric teams proposed a modification to the usual surgical technique of LSG by adding a different fundoplication-Table 1 [11][12][13][14][15][16][17][18]. The intents of these techniques were to minimize the rate of postoperative GERD, to protect the staple line of the angle of His, and finally, to provide a safe and effective alternative for patients with contraindication to LRYGB because of GERD.…”

Section: Introductionmentioning

confidence: 99%

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Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature

et al. 2021

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Background and Objectives: The rising numbers of laparoscopic sleeve gastrectomy (LSG) procedures now being performed worldwide will likely be followed by an increasing number of patients experiencing gastro-esophageal reflux disease (GERD). The purpose of the current review was to analyze in terms of safety different techniques of fundoplication used to treat GERD associated with LSG. Methods: An online search was performed in PubMed/MEDLINE in December 2020 to identify articles reporting LSG and fundoplication. The following term combination was used: (sleeve, fundoplication), (sleeve, Nissen), (sleeve, Rossetti), (sleeve, Toupet) and (sleeve, Dor). The extracted information included details of the methods (e.g., retrospective case series), demographic characteristics (e.g., age, gender), clinical characteristics, number of patients, rate of conversion, and postoperative outcomes. Results: A total of 154 studies were identified and after an assessment of title according to our exclusion criteria, 116 articles were removed. Of the 38 studies analyzed for full content review, a total of seven primary studies (487 patients) were identified with all inclusion criteria. Analyzing the different types of fundoplication used, we have identified: 236 cases of Nissen-Sleeve, 220 cases with modified Rossetti fundoplication, 31 cases of Dor fundoplication, and no case of Toupet fundoplication. The overall postoperative complication rate was 9.4%, with the most common reported complication being gastric perforation, 15 cases—3.1%. The second most common complication was bleeding identified in nine cases (1.8%) followed by gastric stenosis in six cases (1.2%). The mortality was nil. Conclusions: Different types of fundoplication associated with LSG appear to be a safe surgical technique with an acceptable early postoperative complication rate. Any type of fundoplication associated with LSG to decrease GERD should be evaluated cautiously while prospective clinical randomized trials are needed.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature

et al. 2021

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“…While a careful preoperative patients' selection is mandatory, several factors may be implicated in the exacerbation or "de novo" development of postoperative GERD [33]. Decreased gastric emptying, lower LES pressure, blunting the His angle, partial section of the muscular Helvetius collar, decreased gastric compliance/volume, and increased gastric pressure have been advocated as possible influencing factors [29,34,35]. The choice of the most suitable weight-loss procedure should be carefully evaluated especially in patients with a pre-existing clinical or latent GERD.…”

Section: Discussionmentioning

confidence: 99%

“…This may be attributable to the clinical and endoscopic definition of GERD according to the Montreal classification in combination with patients' reporting. Specifically, the correlation between symptoms and esophagitis is not a sensitive marker for pathologic GERD while heartburn may be referred by some patients with esophageal hypersensitivity or functional disorders that are not sustained by a true pathologic reflux [29,45]. Therefore, these data are prone to criticism and, in the future, it would be desirable to obtain more robust evidence by objective data assessment with pH-impedance 24-h study or Bravo pH test evaluation in combination with esophageal manometry [46].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…A study of 70 patients with pre-operative GERD found that after N-sleeve gastrectomy, the prevalence of erosive esophagitis decreased from 99.0% to 30.0% and symptomatic reflux decreased from 76.0% to 1.0%. 70 Another emerging technique for managing reflux following SG is magnetic sphincter augmentation. While not restricted to obese patients, a small retrospective review at a single academic medical center demonstrated a good response.…”

Section: Sleeve Gastrectomymentioning

confidence: 99%

The Effect of Bariatric Surgery and Endoscopic Procedures on Gastroesophageal Reflux Disease

Fass

Mashimo

2021

J Neurogastroenterol Motil

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The Nissen-Sleeve (N-Sleeve): Results of a Cohort Study

Cited by 35 publications

References 27 publications

Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature

Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature

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

The Effect of Bariatric Surgery and Endoscopic Procedures on Gastroesophageal Reflux Disease

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