Laparoscopic sleeve gastrectomy in combination with fundoplication for treatment of obesity accompanying gastroesophageal reflux disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUO Zihao ,  LIU Chang

The Third Department of General Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China;

Corresponding author：

LIU Chang, Email: changliu72@163.com

Keywords：

sleeve gastrectomy; fundoplication; gastroesophageal reflux disease; obesity

DOI：

10.7507/1007-9424.202211067

Video：

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Objective To summarize the mechanism of effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) and the research progress of LSG in combination with fundoplication on obesity with GERD. Method The literatures of studies relevant to relation between LSG and GERD and effect of LSG combined with fundoplication on obesity accompanying GERD at home and abroad were searched and reviewed. Results Although there was considerable disagreement over the effect of LSG on GERD, the evidence showed that the LSG alone might worsen the existing GERD or promote new GERD, which mainly due to the destruction of the lower esophageal sphincter, deactivation of His angle, elevated intragastric pressure, and shape of sleeve stomach. Currently, the LSG in combination with fundoplication had been gradually applied in the clinical treatment of obese patients with GERD. And the short-term results of follow-up showed that the effects of weight loss and anti-reflux could be obtained, which needed to be evaluated by more studies and longer follow-up. Conclusions There is a risk of worsening existing GERD or promoting new GERD after LSG surgery. The LSG in combination with fundoplication is safe and feasible, which not only makes up for the adverse effects of LSG only on GERD after surgery, but also achieves the same similar effect of weight loss as LSG, providing a new choice for obese patients with GERD.

Citation： GUO Zihao, LIU Chang. Laparoscopic sleeve gastrectomy in combination with fundoplication for treatment of obesity accompanying gastroesophageal reflux disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(5): 635-640. doi: 10.7507/1007-9424.202211067 Copy

1.	Wang Y, Zhao L, Gao L, et al. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(7): 446-461.
2.	Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021, 398(10294): 53-63.
3.	Nirwan JS, Hasan SS, Babar ZU, et al. Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis. Sci Rep, 2020, 10(1): 5814. doi: 10.1038/s41598-020-62795-1.
4.	Sharara AI, Rustom LBO, Bou Daher H, et al. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery. Dig Liver Dis, 2019, 51(10): 1375-1379.
5.	Fu S, Xu M, Zhou H, et al. Metabolic syndrome is associated with higher rate of gastroesophageal reflux disease: a meta-analysis. Neurogastroenterol Motil, 2022, 34(5): e14234. doi: 10.1111/nmo.14234.
6.	Castro MJ, Jimenez JM, Carbajo MA, et al. Long-term weight loss results, remission of comorbidities and nutritional deficiencies of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) on type 2 diabetic (T2D) patients. Int J Environ Res Public Health, 2020, 17(20): 7644. doi: 10.3390/ijerph17207644.
7.	Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obes Surg, 2021, 31(5): 1937-1948.
8.	Sljivic S, Gusenoff JA. The obesity epidemic and bariatric trends. Clin Plast Surg, 2019, 46(1): 1-7.
9.	Yeung KTD, Penney N, Ashrafian L, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: a systematic review and meta-analysis. Ann Surg, 2020, 271(2): 257-265.
10.	Genco A, Castagneto-Gissey L, Gualtieri L, et al. GORD and Barrett’s oesophagus after bariatric procedures: multicentre prospective study. Br J Surg, 2021, 108(12): 1498-1505.
11.	杨雄. 胃食管反流病的机制研究及治疗进展. 中国处方药, 2020, 18(4): 28-30.
12.	Fass R, Boeckxstaens GE, El-Serag H, et al. Gastro-oesophageal reflux disease. Nat Rev Dis Primers, 2021, 7(1): 55. doi: 10.1038/s41572-021-00287-w.
13.	Hesse UJ. What causes gastroesophageal reflux following sleeve gastrectomy?. Obes Surg, 2020, 30(2): 759. doi: 10.1007/s11695-019-04262-z.
14.	Gemici E, Kones O, Seyit H, et al. Outcomes of laparoscopic sleeve gastrectomy by means of esophageal manometry and pH-metry, before and after surgery. Wideochir Inne Tech Maloinwazyjne, 2020, 15(1): 129-135.
15.	Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg, 2014, 24(1): 71-77.
16.	Wu JC, Mui LM, Cheung CM, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology, 2007, 132(3): 883-889.
17.	Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg, 2010, 20(3): 357-362.
18.	潘泓多, 孟宪梅, 年媛媛, 等. 胃食管反流病合并食管裂孔疝患者的临床特点分析. 智慧健康, 2021, 7(16): 76-78.
19.	Johari Y, Lim G, Wickremasinghe A, et al. Pathophysiological mechanisms of gastro-esophageal reflux after sleeve gastrectomy. Ann Surg, 2022, 276(5): e407-e416. doi: 10.1097/SLA.0000000000004637.
20.	Keidar A, Appelbaum L, Schweiger C, et al. Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg, 2010, 20(2): 140-147.
21.	Ferraz ÁAB, da Silva JD, Santa-Cruz F, et al. The impact of the gastric twist on esophagitis progression after sleeve gastrectomy: mid-term endoscopic findings. Obes Surg, 2020, 30(11): 4452-4458.
22.	Lazoura O, Zacharoulis D, Triantafyllidis G, et al. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg, 2011, 21(3): 295-299.
23.	Pizza F, D'Antonio D, Lucido FS, et al. Correction to: does antrum size matter in sleeve gastrectomy? A prospective randomized study. Surg Endosc, 2021, 35(7): 3533. doi: 10.1007/s00464-020-07863-3.
24.	Baumann T, Grueneberger J, Pache G, et al. Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc, 2011, 25(7): 2323-2329.
25.	King K, Sudan R, Bardaro S, et al. Assessment and management of gastroesophageal reflux disease following bariatric surgery. Surg Obes Relat Dis, 2021, 17(11): 1919-1925.
26.	Assalia A, Gagner M, Nedelcu M, et al. Gastroesophageal reflux and laparoscopic sleeve gastrectomy: results of the first inter-national consensus conference. Obes Surg, 2020, 30(10): 3695-3705.
27.	Amor IB, Casanova V, Vanbiervliet G, et al. The Nissen-sleeve (N-Sleeve): results of a cohort study. Obes Surg, 2020, 30(9): 3267-3272.
28.	Nocca D, Skalli EM, Boulay E, et al. Nissen Sleeve (N-Sleeve) operation: preliminary results of a pilot study. Surg Obes Relat Dis, 2016, 12(10): 1832-1837.
29.	Lasnibat JP, Braghetto I, Gutierrez L, et al. Sleeve gastrectomy and fundoplication as a single procedure in patients with obesity and gastroesophageal reflux. Arq Bras Cir Dig, 2017, 30(3): 216-221.
30.	Türkçapar AG, Şen O. Combined partial Toupet fundoplication with laparoscopic sleeve gastrectomy for patients with morbid obesity and symptomatic GERD: preliminary results of the t-sleeve technique. Surg Laparosc Endosc Percutan Tech, 2022, 32(3): 324-328.
31.	Hauters P, van Vyve E, Stefanescu I, et al. A case-control comparative study between Toupet-Sleeve and conventional sleeve gastrectomy in patients with preoperative gastroesophageal reflux. Acta Chir Belg, 2023, 123(1): 19-25.
32.	Del Genio G, Tolone S, Gambardella C, et al. Sleeve gastrectomy and anterior fundoplication (D-Sleeve) prevents gastroesophageal reflux in symptomatic GERD. Obes Surg, 2020, 30(5): 1642-1652.
33.	Olmi S, Cesana G, Gambioli A, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic sleeve + Rossetti fundoplication on weight loss and de novo GERD in patients affected by morbid obesity: a randomized clinical study. Obes Surg, 2022, 32(5): 1451-1458.
34.	Olmi S, Uccelli M, Cesana GC, et al. Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-month follow-up. Surg Obes Relat Dis, 2020, 16(9): 1202-1211.
35.	Nissen R. A simple operation for control of reflux esophagitis. Schweiz Med Wochenschr, 1956, 86(Suppl 20): 590-592.
36.	Håkanson BS, Lundell L, Bylund A, et al. Comparison of laparoscopic 270° posterior partial fundoplication vs total fundoplication for the treatment of gastroesophageal reflux disease: a randomized clinical trial. JAMA Surg, 2019, 154(6): 479-486.
37.	Du X, Wu JM, Hu ZW, et al. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease: a meta-analysis and systematic review. Medicine (Baltimore), 2017, 96(37): e8085. doi: 10.1097/MD.0000000000008085.
38.	胡志伟, 李冉, 邓昌荣, 等. 腹腔镜Nissen-Rossetti胃底折叠术治疗质子泵抑制剂依赖性胃食管反流病的效果分析. 中国医学前沿杂志(电子版), 2021, 13(1): 73-79.

1. Wang Y, Zhao L, Gao L, et al. Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol, 2021, 9(7): 446-461.
2. Wang L, Zhou B, Zhao Z, et al. Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004-18. Lancet, 2021, 398(10294): 53-63.
3. Nirwan JS, Hasan SS, Babar ZU, et al. Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis. Sci Rep, 2020, 10(1): 5814. doi: 10.1038/s41598-020-62795-1.
4. Sharara AI, Rustom LBO, Bou Daher H, et al. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery. Dig Liver Dis, 2019, 51(10): 1375-1379.
5. Fu S, Xu M, Zhou H, et al. Metabolic syndrome is associated with higher rate of gastroesophageal reflux disease: a meta-analysis. Neurogastroenterol Motil, 2022, 34(5): e14234. doi: 10.1111/nmo.14234.
6. Castro MJ, Jimenez JM, Carbajo MA, et al. Long-term weight loss results, remission of comorbidities and nutritional deficiencies of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) on type 2 diabetic (T2D) patients. Int J Environ Res Public Health, 2020, 17(20): 7644. doi: 10.3390/ijerph17207644.
7. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obes Surg, 2021, 31(5): 1937-1948.
8. Sljivic S, Gusenoff JA. The obesity epidemic and bariatric trends. Clin Plast Surg, 2019, 46(1): 1-7.
9. Yeung KTD, Penney N, Ashrafian L, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: a systematic review and meta-analysis. Ann Surg, 2020, 271(2): 257-265.
10. Genco A, Castagneto-Gissey L, Gualtieri L, et al. GORD and Barrett’s oesophagus after bariatric procedures: multicentre prospective study. Br J Surg, 2021, 108(12): 1498-1505.
11. 杨雄. 胃食管反流病的机制研究及治疗进展. 中国处方药, 2020, 18(4): 28-30.
12. Fass R, Boeckxstaens GE, El-Serag H, et al. Gastro-oesophageal reflux disease. Nat Rev Dis Primers, 2021, 7(1): 55. doi: 10.1038/s41572-021-00287-w.
13. Hesse UJ. What causes gastroesophageal reflux following sleeve gastrectomy?. Obes Surg, 2020, 30(2): 759. doi: 10.1007/s11695-019-04262-z.
14. Gemici E, Kones O, Seyit H, et al. Outcomes of laparoscopic sleeve gastrectomy by means of esophageal manometry and pH-metry, before and after surgery. Wideochir Inne Tech Maloinwazyjne, 2020, 15(1): 129-135.
15. Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of “de novo” gastroesophageal reflux. Obes Surg, 2014, 24(1): 71-77.
16. Wu JC, Mui LM, Cheung CM, et al. Obesity is associated with increased transient lower esophageal sphincter relaxation. Gastroenterology, 2007, 132(3): 883-889.
17. Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients. Obes Surg, 2010, 20(3): 357-362.
18. 潘泓多, 孟宪梅, 年媛媛, 等. 胃食管反流病合并食管裂孔疝患者的临床特点分析. 智慧健康, 2021, 7(16): 76-78.
19. Johari Y, Lim G, Wickremasinghe A, et al. Pathophysiological mechanisms of gastro-esophageal reflux after sleeve gastrectomy. Ann Surg, 2022, 276(5): e407-e416. doi: 10.1097/SLA.0000000000004637.
20. Keidar A, Appelbaum L, Schweiger C, et al. Dilated upper sleeve can be associated with severe postoperative gastroesophageal dysmotility and reflux. Obes Surg, 2010, 20(2): 140-147.
21. Ferraz ÁAB, da Silva JD, Santa-Cruz F, et al. The impact of the gastric twist on esophagitis progression after sleeve gastrectomy: mid-term endoscopic findings. Obes Surg, 2020, 30(11): 4452-4458.
22. Lazoura O, Zacharoulis D, Triantafyllidis G, et al. Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg, 2011, 21(3): 295-299.
23. Pizza F, D'Antonio D, Lucido FS, et al. Correction to: does antrum size matter in sleeve gastrectomy? A prospective randomized study. Surg Endosc, 2021, 35(7): 3533. doi: 10.1007/s00464-020-07863-3.
24. Baumann T, Grueneberger J, Pache G, et al. Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration. Surg Endosc, 2011, 25(7): 2323-2329.
25. King K, Sudan R, Bardaro S, et al. Assessment and management of gastroesophageal reflux disease following bariatric surgery. Surg Obes Relat Dis, 2021, 17(11): 1919-1925.
26. Assalia A, Gagner M, Nedelcu M, et al. Gastroesophageal reflux and laparoscopic sleeve gastrectomy: results of the first inter-national consensus conference. Obes Surg, 2020, 30(10): 3695-3705.
27. Amor IB, Casanova V, Vanbiervliet G, et al. The Nissen-sleeve (N-Sleeve): results of a cohort study. Obes Surg, 2020, 30(9): 3267-3272.
28. Nocca D, Skalli EM, Boulay E, et al. Nissen Sleeve (N-Sleeve) operation: preliminary results of a pilot study. Surg Obes Relat Dis, 2016, 12(10): 1832-1837.
29. Lasnibat JP, Braghetto I, Gutierrez L, et al. Sleeve gastrectomy and fundoplication as a single procedure in patients with obesity and gastroesophageal reflux. Arq Bras Cir Dig, 2017, 30(3): 216-221.
30. Türkçapar AG, Şen O. Combined partial Toupet fundoplication with laparoscopic sleeve gastrectomy for patients with morbid obesity and symptomatic GERD: preliminary results of the t-sleeve technique. Surg Laparosc Endosc Percutan Tech, 2022, 32(3): 324-328.
31. Hauters P, van Vyve E, Stefanescu I, et al. A case-control comparative study between Toupet-Sleeve and conventional sleeve gastrectomy in patients with preoperative gastroesophageal reflux. Acta Chir Belg, 2023, 123(1): 19-25.
32. Del Genio G, Tolone S, Gambardella C, et al. Sleeve gastrectomy and anterior fundoplication (D-Sleeve) prevents gastroesophageal reflux in symptomatic GERD. Obes Surg, 2020, 30(5): 1642-1652.
33. Olmi S, Cesana G, Gambioli A, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic sleeve + Rossetti fundoplication on weight loss and de novo GERD in patients affected by morbid obesity: a randomized clinical study. Obes Surg, 2022, 32(5): 1451-1458.
34. Olmi S, Uccelli M, Cesana GC, et al. Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-month follow-up. Surg Obes Relat Dis, 2020, 16(9): 1202-1211.
35. Nissen R. A simple operation for control of reflux esophagitis. Schweiz Med Wochenschr, 1956, 86(Suppl 20): 590-592.
36. Håkanson BS, Lundell L, Bylund A, et al. Comparison of laparoscopic 270° posterior partial fundoplication vs total fundoplication for the treatment of gastroesophageal reflux disease: a randomized clinical trial. JAMA Surg, 2019, 154(6): 479-486.
37. Du X, Wu JM, Hu ZW, et al. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease: a meta-analysis and systematic review. Medicine (Baltimore), 2017, 96(37): e8085. doi: 10.1097/MD.0000000000008085.
38. 胡志伟, 李冉, 邓昌荣, 等. 腹腔镜Nissen-Rossetti胃底折叠术治疗质子泵抑制剂依赖性胃食管反流病的效果分析. 中国医学前沿杂志(电子版), 2021, 13(1): 73-79.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic sleeve gastrectomy in combination with fundoplication for treatment of obesity accompanying gastroesophageal reflux disease

Abstract Full text Figures/Tables Video References Cited by

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