The Mid-term Efficacy of Sleeve-Nissen Versus Sleeve-Toupet Fundoplication for the Management of Gastroesophageal Reflux Disease in Patients with Obesity.

BACKGROUND

Sleeve gastrectomy with fundoplication is emerging as a new surgical option for obesity with gastroesophageal reflux disease (GERD). However, comparative data on different fundoplication techniques combined with sleeve gastrectomy are limited.

OBJECTIVES

To compare the mid-term efficacy of sleeve gastrectomy with Nissen fundoplication (SGNF) versus sleeve gastrectomy with Toupet fundoplication (SGTF) in patients affected by obesity with GERD.

METHODS

This retrospective study enrolled 54 patients affected by obesity with GERD who underwent SGNF or SGTF between January 2019 and November 2023.

RESULTS

Of 54 initially enrolled patients, 3 were lost to follow-up. The remaining 51 were analyzed: 24 underwent SGNF and 27 underwent SGTF. Postoperative hospital stay was significantly longer in the SGNF group (5.5 [4, 7] days), compared to the SGTF group (4 [3, 5] days) (P = 0.002). At 3-5 years after surgery, mean %TWL was 25.77 ± 7.71% in the SGNF group and 28.16 ± 10.59% in the SGTF group (P = 0.475). Remission of GERD was seen in 75.0% (SGNF) and 72.7% (SGTF) of patients (P = 0.846); both groups showed a significant decrease in GERD-Q scores from baseline (P < 0.001). Endoscopic follow-up demonstrated esophagitis decreased from 23.5% preoperatively to 8.0% postoperatively in the combined cohort.

CONCLUSIONS

SGNF and SGTF were shown to be a safe and effective intervention with comparative outcomes at mid-term follow-up. A prospective randomized clinical trial with longer follow-up is needed to elucidate the long-term outcomes.