Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-month follow-up

Olmi, Stefano; Uccelli, Matteo; Cesana, Giovanni; Ciccarese, Francesca; Oldani, Alberto; Giorgi, Riccardo; Carli, Stefano Maria De; Villa, Roberta

doi:10.1016/j.soard.2020.03.029

Cited by 21 publications

(17 citation statements)

References 34 publications

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“…In an attempt to explore medium-term follow-up data, Olmi and colleagues reported data for 58 patients that concluded the 2-year follow-up analysis. The reported BMI and %EWL were 27.8 and 74.4%, respectively [30]. In another study by da Silva et al, 33 patients were followed up and completed the 3-year postoperative evaluation.…”

Section: Discussionmentioning

confidence: 96%

“…The related heterogeneity was 0.0% and the sensitivity analysis added robustness to the result. The wrapping of the His angle with the antireflux valve has been proposed as a possible protective factor with a reduced leak risk [30]. The rationale is to cover the His angle moving the staple line to a better vascularized area [27].…”

Section: Discussionmentioning

confidence: 99%

“…The postoperative gastric perforation is an event that is totally different from leak, that is the reason why we performed two different quantitative analyses. Different theories have been risen ranging from incongruous manipulation of the gastric fundus during the operation, incorrect grasper handling, thermic injury, to inadequate gastric valve vascularization even in the presence of large intramural vessels and gastric valve perfusion at the intraoperative green indocyanine test [27,30]. Caution is mandatory while interpreting this outcome because of potentially being influenced by diverse surgical techniques, surgeons' experience, valve anatomy, outcomes reporting, definition of postoperative complications, preoperative comorbidities, and patients' selection bias.…”

Section: Discussionmentioning

confidence: 99%

“…The authors reported the creation of a small retroesophageal window for the passage of the fundus without leaving a wide space. Furthermore, the fundoplication was fashioned with only gastro-gastric stitches and not sutured to the esophagus to avoid vagal nerve injuries and prevent gastric emptying disorders [30]. Other authors described a Nissen-sleeve fundoplication with a more extended esophageal dissection in the posterior mediastinum to obtain at least 5 cm of intra-abdominal esophagus.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Sleeve-Fundoplication for Morbidly Obese Patients with Gastroesophageal Reflux: Systematic Review and Meta-analysis

et al. 2021

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Introduction Laparoscopic sleeve gastrectomy (LSG) has rapidly become popular with excellent results. However, LSG may exacerbate or increase the risk of “de novo” gastroesophageal reflux disease (GERD). Adding a fundoplication has been proposed to increase the lower esophageal sphincter competency. The aim of this study was to examine the current evidence and outcomes of sleeve-fundoplication (Sleeve-F). Materials and Methods Systematic review and meta-analysis. Web of Science, PubMed, and Embase data sets were consulted. Results Six studies (485 patients) met the inclusion criteria. The age of the patient population ranged from 17 to 72 years old and 82% were females. All patients underwent sleeve-fundoplication. Rossetti, Collis-Nissen, and Nissen were the most commonly performed fundoplications. The estimated pooled prevalence of postoperative leak, gastric perforation, and overall complications were 1.0% (95% CI = 0.0–2.0%), 2.9% (95% CI = 0.0–8.3%), and 9.8% (95% CI = 6.7–13.4%), respectively. The pooled reoperation rate was 4.1% (95% CI = 1.3–10%). There was no mortality. At 12-month follow-up, the estimated pooled BMI and %EWL were 29.9 kg/m2 (95% CI = 28.5–31.2) and 66.2% (95% CI = 59.3–71.1), respectively, while esophagitis, PPI consumption, and GERD rates were 8.0% (95% CI 3–21%), 7.8% (95% CI 5–13%), and 11% (95% CI 4–26%). Conclusions This systematic review and meta-analysis shows that current evidence for Sleeve-F is limited with high postoperative gastric perforation and overall complication rates. Weight loss and GERD resolution seem promising in the short term; however, further studies are warranted to explore long-term effects with instrumental investigations. Sleeve-F should be considered cautiously while future well-structured randomized trials are warranted.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Sleeve-Fundoplication for Morbidly Obese Patients with Gastroesophageal Reflux: Systematic Review and Meta-analysis

et al. 2021

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“…Considering all these findings, several bariatric teams proposed a modification to the usual surgical technique of LSG by adding a different fundoplication-Table 1 [11][12][13][14][15][16][17][18]. The intents of these techniques were to minimize the rate of postoperative GERD, to protect the staple line of the angle of His, and finally, to provide a safe and effective alternative for patients with contraindication to LRYGB because of GERD.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Authors Response from Letter to the Editor Concerning: Bures C, Benzing C, Marchesini JC, Sobottka WH, Sadowski JA, Marchesini JB, Zorron R. The “Hug” Technique Roux-en-Y Gastric Bypass with Preservation of the Posterior Wrap in Patients with Nissen Fundoplication: a Simple Solution for a Complex Problem

Marchesini

2020

OBES SURG

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Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: results after 220 procedures with 24-month follow-up

Cited by 21 publications

References 34 publications

Laparoscopic Sleeve-Fundoplication for Morbidly Obese Patients with Gastroesophageal Reflux: Systematic Review and Meta-analysis

Laparoscopic Sleeve-Fundoplication for Morbidly Obese Patients with Gastroesophageal Reflux: Systematic Review and Meta-analysis

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

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