Efficacy of combined sleeve gastrectomy and nissen fundoplication for weight loss and prevention of postoperative gastroesophageal reflux disease in patients with obesity: a systematic review and meta-analysis.

Abstract

The addition of a Nissen fundoplication to the sleeve gastrectomy (SG) has been recently proposed to reduce the incidence of postoperative gastroesophageal reflux disease (GERD). The aim of this study was to assess the effectiveness and safety of laparoscopic Nissen Sleeve (LNS). A systematic review using the Medline database was performed to identify original articles analyzing outcomes after LNS. Main outcomes included weight loss, improvement of GERD symptoms, esophagitis, proton pump inhibitor (PPI) usage, and pH monitoring. Postprocedural complications were included as secondary outcomes. A meta-analysis of proportions and paired preintervention and postintervention tests were used to assess the effect of the procedure on the different outcomes. A total of 5 studies comprising 246 patients undergoing LNS were included in the analysis. Mean age was 43.22 (40-46.2) years and 201 (85.12%) were females. The mean preoperative body mass index (BMI) of patients was 38.10 (33.9-40.4) kg/m². After a mean follow up of 27 (12-60) months, there was a significant reduction in mean BMI (pre: 38.10 versus post: 29.36, P < .007) and a mean excess weight loss (EWL) of 59.10% (26%-82%). The proportion of patients with GERD symptoms (pre: 80.16% versus post: 11.22%, P = .001) were significantly reduced after the operation. The use of PPIs (pre: 69% versus post: 8.98%, P = .10) and presence of esophagitis (pre: 69.6% versus post: 18%, P = .05) also reduced after the procedure, but this was not statiscally significant. Overall morbidity rate was 4% (95% confidence interval [CI], 1%-11%), with a weighted pooled proportion of 2% (95% CI, 0%-6%) for leaks, 2% (95% CI, 1%-5%) for strictures, 1% (95% CI, 1%-3%) for bleeding, and 3% (95% CI, 1%-5%) for perforation. LNS seems to be a safe and effective operation with apparently better GERD-related outcomes than SG alone. Further studies with longer follow-up and objective measurement of reflux are needed to confirm the successful outcomes of the procedure.