Gastric greater curvature plication combined with Nissen fundoplication compared to sleeve gastrectomy in patients with obesity and animal model.

Abstract

Background: Gastric greater curvature plication combined with Nissen fundoplication (GGCP + Nissen) has been previously performed, but its efficacy remains uncertain.

Methods: A single-center retrospective review was conducted on patients with obesity who underwent GGCP + Nissen or sleeve gastrectomy (SG) between January 2016 and December 2022. Both groups were matched for age, gender, and baseline BMI. In the animal experiments, GGCP + Nissen, SG, and sham procedures were performed on Goto-Kakizaki rats, a model of normal-weight rats with T2DM.

Results: A total of 75 patients were included in this study, of whom 35 underwent GGCP + Nissen, and 40 underwent SG. Both groups were matched for age, gender, and baseline BMI. The percent total weight loss (%TWL) in the GGCP + Nissen and SG groups were 16.38 ± 3.69 and 25.05 ± 7.24 at 6 months (P < 0.05), 16.40 ± 4.96 and 26.85 ± 9.13 at 12 months (P < 0.05), and 12.46 ± 5.90 and 24.57 ± 8.61 at 24 months (P < 0.05), respectively. However, all 8 patients with preoperative reflux in the GGCP + Nissen group achieved complete resolution of symptoms postoperatively, whereas in the SG group, 10 patients developed new-onset reflux at 1 month, with 4 continuing to experience persistent symptoms at 24-month follow-up. In the animal experiments, both GGCP + Nissen and SG induced significant weight loss and improved glucose tolerance, with rats showing increased insulin sensitivity and secretion. However, the SG group performed better than the GGCP + Nissen group in terms of both weight loss and improvement of glucose tolerance.

Conclusions: GGCP + Nissen was inferior to SG both in weight loss and improvement of glucose tolerance, although GGCP + Nissen could lead a substantial weight loss and improve GERD efficiently.