Laparoscopic Sleeve-Collis-Nissen Gastroplasty: a Safe Alternative for Morbidly Obese Patients with Gastroesophageal Reflux Disease.

BACKGROUND: Some studies have recently suggested that laparoscopic sleeve gastrectomy may exacerbate gastroesophageal reflux disease (GERD) symptoms or even increase the risk of "de novo" post-operative GERD. We herein describe and evaluate the initial response of an alternative technique of sleeve gastroplasty combined with Nissen fundoplication for morbidly obese patients who present significant GERD.

METHODS: From January 2008 to December 2013, 122 morbidly obese patients underwent laparoscopic Sleeve-Collis-Nissen gastroplasty (LSCNG).

RESULTS: The great majority of the patients were female (97.5 %), with a mean age of 42.4 years old (from 18 to 72). Hiatal hernia and use of proton pump inhibitors (PPIs) were presented in 54.9 and 92 %, respectively. The mean operative time was 91 ± 6 min. The mean hospitalization stay was 2 ± 0.3 days. Major complications including stenosis requiring endoscopic dilation and GI bleeding were observed in five patients (4.1 %). No leaks were observed. One-year follow-up showed a significant decrease in the prevalence of esophagitis (100 vs 13.6 %) and the use of PPIs (92 vs 13.6 %). The percentages of excess weight loss 1 and 3 years after the surgery were 64.4 ± 7.2 and 60.4 ± 8.1 %, respectively.

CONCLUSIONS: LSCNG is a novel, technically feasible surgery with a low incidence of procedure-related complications. However, further prospective studies are required to assess the real impact of this procedure on the improvement of GERD symptoms.