Antireflux effect of nissen fundoplication combined with sleeve gastrectomy in comparison with laparoscopic Roux-en-Y gastric bypass | Ukrainian Medical Journal

Gastroesophageal reflux disease (GERD) commonly accompanies severe obesity, whereas standard laparoscopic sleeve gastrectomy may induce or worsen reflux. The aim of this study was to evaluate the antireflux effect of Nissen-augmented laparoscopic sleeve gastrectomy (N-LSG) compared with laparoscopic Roux-en-Y gastric bypass (LRYGB) and to analyze possible pathophysiological mechanisms of the fundoplication wrap. A prospective non-randomized comparative study with parallel groups included 41 patients after N-LSG and 55 after LRYGB. Preoperative assessment included GERD-HRQL, esophagogastroduodenoscopy, and 24-hour pH-impedance monitoring; objective GERD verification and phenotyping were performed according to Lyon 2.0 criteria. At 12 months, composite GERD remission was achieved in 80.5% of patients after N-LSG and in 72.7% after LRYGB (p=0.471). N-LSG was associated with lower GERD-HRQL scores, fewer reflux and acid episodes, and a lower prevalence of LA esophagitis. In the Lyon 2.0 grey zone subgroup, N-LSG demonstrated a higher PSPW index. N-LSG may be considered a promising antireflux bariatric option for patients with a dominant reflux phenotype, particularly within the Lyon 2.0 grey zone.

References

1. GBD 2021 Adult BMI Collaborators. (2025) Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: A forecasting study for the Global Burden of Disease Study 2021. The Lancet, 405(10481): 813–838. doi.org/10.1016/S0140-6736(25)00355-1.
2. Eisenberg D., Shikora S.A., Aarts E. et al. (2023) 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obesity Surg., 33(1): 3–14. doi.org/10.1007/s11695-022-06332-1.
3. Peterli R., Wölnerhanssen B.K., Peters T. et al. (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: The SM-BOSS randomized clinical trial. JAMA, 319(3): 255–265. doi.org/10.1001/jama.2017.20897.
4. Salminen P., Grönroos S., Helmiö M. et al. (2022) Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: The SLEEVEPASS randomized clinical trial. JAMA Surg., 157(8): 656–666. doi.org/10.1001/jamasurg.2022.2229.
5. Biter L.U., ’t Hart J.W.H., Noordman B.J. et al. (2024) Long-term effect of sleeve gastrectomy versus Roux-en-Y gastric bypass in people living with severe obesity: A phase III multicentre randomised controlled trial (SleeveBypass). The Lancet Regional Health — Europe, 38: Article 100836. doi.org/10.1016/j.lanepe.2024.100836.
6. Nocca D., Skalli E.M., Boulay E. et al. (2016) Nissen sleeve (N-sleeve) operation: Preliminary results of a pilot study. Surg. Obes. Related Dis., 12(10): 1832–1837. doi.org/10.1016/j.soard.2016.02.010.
7. Mu S.Z., Saber A.A. (2024) Gastroesophageal reflux disease and weight loss after fundoplication sleeve gastrectomy: A systematic review and meta-analysis. Obesity Surg., 34(2): 318–329. doi.org/10.1007/s11695-023-06927-2.
8. Loo J.H., Chue K.M., Lim C.H. et al. (2024) Effectiveness of sleeve gastrectomy plus fundoplication versus sleeve gastrectomy alone for treatment of patients with severe obesity: A systematic review and meta-analysis. Surgery for Obesity and Related Diseases, 20(6): 532–543. doi.org/10.1016/j.soard.2023.12.007.
9. Ben Amor I., Casanova V., Vanbiervliet G. et al. (2020) The Nissen-sleeve (N-sleeve): Results of a cohort study. Obesity Surg., 30(9): 3267–3272. doi.org/10.1007/s11695-020-04469-5.
10. Savvala N., Amico M., Joumaa S. et al. (2025) Nissen sleeve gastrectomy: 5-year follow-up results. Surg. Obes. Related Dis., 21(3): 311–318. doi.org/10.1016/j.soard.2024.10.019.
11. Gyawali C.P., Yadlapati R., Fass R. et al. (2024) Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut, 73(2): 361–371. doi.org/10.1136/gutjnl-2023-330616.
12. Olmi S., Uccelli M., Cesana G.C. et al. (2020) Modified laparoscopic sleeve gastrectomy with Rossetti antireflux fundoplication: Results after 220 procedures with 24-month follow-up. Surg. Obes. Related Dis., 16(9): 1202–1211. doi.org/10.1016/j.soard.2020.03.029.
13. Aiolfi A., Micheletto G., Marin J. et al. (2021) Laparoscopic sleeve-fundoplication for morbidly obese patients with gastroesophageal reflux: Systematic review and meta-analysis. Obes. Surg., 31(4): 1714–1721. doi.org/10.1007/s11695-020-05189-6.
14. Castagneto-Gissey L., Russo M.F., Palumbo P. et al. (2023) Efficacy of sleeve gastrectomy with concomitant hiatal hernia repair versus sleeve-fundoplication on gastroesophageal reflux disease resolution and weight loss: A systematic review and meta-analysis. J. Clin. Med., 12(9): Article 3323. doi.org/10.3390/jcm12093323.
15. Grönroos S., Helmiö M., Juuti A. et al. (2021) Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years in patients with morbid obesity: The SLEEVEPASS randomized clinical trial. JAMA Surg., 156(2): 137–146. doi.org/10.1001/jamasurg.2020.5666.
16. Herbella F.A., Patti M.G. (2010) Gastroesophageal reflux disease: From pathophysiology to treatment. World J. Gastroenterol., 16(30): 3745–3749. doi.org/10.3748/wjg.v16.i30.3745.
17. Savarino E., Zentilin P., Tutuian R. et al. (2012) Impedance-pH reflux patterns can differentiate non-erosive reflux disease from functional heartburn patients. J. Gastroenterol., 47(2): 159–168. doi.org/10.1007/s00535-011-0480-0.
18. Carter P.R., LeBlanc K.A., Hausmann M.G. et al. (2011) Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surg. Obes. Related Dis., 7(5): 569–572. doi.org/10.1016/j.soard.2011.01.040.
19. Salame M., Jawhar N., Belluzzi A. et al. (2023) Marginal ulcers after Roux-en-Y gastric bypass: Etiology, diagnosis, and management. J. Clin. Med., 12(13): Article 4336. doi.org/10.3390/jcm12134336.
20. Principe J., Angeramo C.A., Bertona S. et al. (2025) Efficacy of combined sleeve gastrectomy and Nissen fundoplication for weight loss and prevention of postoperative gastroesophageal reflux disease in patients with obesity: A systematic review and meta-analysis. Surg. Obes. Related Dis., 21(7): 829–837. doi.org/10.1016/j.soard.2025.02.008.
21. Kurmanskyi A., Tkachuk O., Kebkalo A. (2025) Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy: Risk factors and diagnostic aspects. Polski Przegląd Chirurgiczny, 97(5): 31–36. doi.org/10.5604/01.3001.0055.2330.