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

Abstract

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.

Combined Partial Toupet Fundoplication With Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity and Symptomatic GERD: Preliminary Results of the T-sleeve Technique

“…Nocca et al18 were the first to describe Nissen fundoplication in the same session as LSG and termed this method as “Nissen-Sleeve.” One of the major concerns in this new method was whether resection after 360-degree fundoplication would create an ischemic problem in the wrap. There have been reported cases of postoperative perforation with this method 23…”

“…There have been reported cases of postoperative perforation with this method. 23 RYGB is the most commonly preferred bariatric surgical method in morbidly obese patients with a history of previous antireflux surgery. However, the complication rates (20% to 38%) are quite high in the series.…”

The Impact of Bariatric Procedures on Esophageal Motility

“…Experience with magnetic ring augmentation of the LES is too limited to be conclusive. 48 A Hill cardiopexy 68 and different types of fundoplication 69 have also been added to sleeve gastrectomy. Obviously, a fundoplication can only be used as a remedial procedure, since the gastric fundus must be preserved for this purpose.…”

Gastrectomia vertical com piloroplastia em ratos Wistar: avaliação do esvaziamento gástrico, do trânsito intestinal e do possível refluxo alcalino duodeno-gástrico

“…Recentemente vêm sendo descritas adequações e complementações técnicas da GV, visando melhorar os resultados relacionados à DRGE. O papel fisiopatológico da região de transição esofagogástrica e seus mecanismos antirefluxo são foco de muitos pesquisadores (AIOLFI et al, 2021;CARANDINA et al,2021). O papel do estômago nesse processo também é conhecido e explorado (WANG et al, 2018;VALADÃO et al, 2020).…”

“…Artigos de revisão evidenciam que procedimentos complementares relacionados a fundoplicaturas são mais complexos e com curva de aprendizado maior, porém seguros, com baixas complicações. Concluem haver benefícios relacionados ao refluxo patológico, porém não sendo possível ainda afirmar, em longo prazo e definitivamente, como preventivos da DGRE após gastrectomia vertical (BO-QIANG et al, 2020;AIOLFI et al, 2021;CARANDINA et al, 2021).…”