Laparoscopic Sleeve-Collis-Nissen Gastroplasty: a Safe Alternative for Morbidly Obese Patients with Gastroesophageal Reflux Disease

Obes Surg. 2015 Jul;25(7):1217-22. doi: 10.1007/s11695-014-1523-4.

Abstract

Background: Some studies have recently suggested that laparoscopic sleeve gastrectomy may exacerbate gastroesophageal reflux disease (GERD) symptoms or even increase the risk of "de novo" post-operative GERD. We herein describe and evaluate the initial response of an alternative technique of sleeve gastroplasty combined with Nissen fundoplication for morbidly obese patients who present significant GERD.

Methods: From January 2008 to December 2013, 122 morbidly obese patients underwent laparoscopic Sleeve-Collis-Nissen gastroplasty (LSCNG).

Results: The great majority of the patients were female (97.5 %), with a mean age of 42.4 years old (from 18 to 72). Hiatal hernia and use of proton pump inhibitors (PPIs) were presented in 54.9 and 92 %, respectively. The mean operative time was 91 ± 6 min. The mean hospitalization stay was 2 ± 0.3 days. Major complications including stenosis requiring endoscopic dilation and GI bleeding were observed in five patients (4.1 %). No leaks were observed. One-year follow-up showed a significant decrease in the prevalence of esophagitis (100 vs 13.6 %) and the use of PPIs (92 vs 13.6 %). The percentages of excess weight loss 1 and 3 years after the surgery were 64.4 ± 7.2 and 60.4 ± 8.1 %, respectively.

Conclusions: LSCNG is a novel, technically feasible surgery with a low incidence of procedure-related complications. However, further prospective studies are required to assess the real impact of this procedure on the improvement of GERD symptoms.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Fundoplication / methods*
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / surgery*
  • Gastroplasty / methods*
  • Hernia, Hiatal / complications
  • Hernia, Hiatal / surgery
  • Humans
  • Laparoscopy / methods*
  • Length of Stay
  • Male
  • Middle Aged
  • Obesity, Morbid / complications
  • Obesity, Morbid / surgery*
  • Prospective Studies
  • Proton Pump Inhibitors / therapeutic use
  • Treatment Outcome
  • Weight Loss
  • Young Adult

Substances

  • Proton Pump Inhibitors