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Randomized Controlled Trial
. 2022 May;32(5):1451-1458.
doi: 10.1007/s11695-022-05955-8. Epub 2022 Feb 8.

Effect of laparoscopic sleeve gastrectomy vs laparoscopic sleeve + Rossetti fundoplication on weight loss and de novo GERD in patients affected by morbid obesity: a randomized clinical study

Stefano Olmi  1   2 , Giovanni Cesana  3   4 , Angela Gambioli  5 , Marta Bonaldi  1 , Davide Ferrari  1   6 , Matteo Uccelli  1 , Francesca Ciccarese  1   6 , De Carli Stefano  1 , Giorgi Riccardo  1 , Mantovani Lorenzo  5
Affiliations
Randomized Controlled Trial

Effect of laparoscopic sleeve gastrectomy vs laparoscopic sleeve + Rossetti fundoplication on weight loss and de novo GERD in patients affected by morbid obesity: a randomized clinical study

Stefano Olmi et al. Obes Surg. 2022 May.

Erratum in

Abstract

Purpose: To compare sleeve gastrectomy (SG) to SG associated with Rossetti fundoplication (SG + RF) in terms of de novo gastro-esophageal reflux disease (GERD) after surgery, weight loss, and postoperative complications.

Materials and methods: Patients affected by morbid obesity, without symptoms of GERD, who were never in therapy with proton pump inhibitors (PPIs), were randomized into two groups. One group underwent SG and the other SG + RF. The study was stopped on February 2020 due to the COVID pandemic.

Results: A total of 278 patients of the programmed number of 404 patients were enrolled (68.8%). De novo esophagitis was considered in those patients who had both pre- and postoperative gastroscopy (97/278, 34.9%). Two hundred fifty-one patients (90.3%) had completed clinical follow-up at 12 months. SG + RF resulted in an adequate weight loss, similar to classic SG at 12-month follow-up (%TWL = 35. 4 ± 7.2%) with a significantly better outcome in terms of GERD development. One year after surgery, PPIs were necessary in 4.3% SG + RF patients compared to 17.1% SG patients (p = 0.001). Esophagitis was present in 2.0% of SG + RF patients versus 23.4% SG patients (p = 0.002). The main complication after SG + RF was wrap perforation (4.3%), which improved with the surgeon's learning curve.

Conclusion: SG + RF seemed to be an effective alternative to classic SG in preventing de novo GERD. More studies are needed to establish that an adequate learning curve decreases the higher percentage of short-term complications in the SG + RF group.

Keywords: GERD; Nissen sleeve; Obesity; Rossetti sleeve.

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Conflict of interest statement

All the authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Variations of BMI before and after surgery are compared in the SG population and the SG + RF population. 126 patients out of 140 (90%) in the SG group and 125 out of 138 in the SG + RF group (90.6%) completed follow up. BMI = body mass index, SG = sleeve gastrectomy, SG + RF = sleeve gastrectomy + Rossetti fundoplication
Fig. 2
Fig. 2
Variations in co-morbidities measured as the necessity to assume at least 1 drug for pathology. The follow up was completed for 126/140 (90%) in the SG group and 125/138 in the SG + RF group (90.6%). T2D = type 2 diabetes, HTN = hypertension, CPAP = continuous positive airways pressure
Fig. 3
Fig. 3
Fundoplication perforation considering the trial’s time frame. Each point in the graph corresponds to an intervention. On the x-axis: date of intervention. On the y-axis: 0 = no perforation; 1 = perforation
See this image and copyright information in PMC

References

    1. Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–3794. doi: 10.1007/s11695-018-3450-2. - DOI - PubMed
    1. Yeung KTD, Penney N, Ashrafian L, Darzi A, Ashrafian H. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: a systematic review and meta-analysis. Ann Surg. 2020;271(2):257–265. doi: 10.1097/SLA.0000000000003275. - DOI - PubMed
    1. Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(4):710–714. doi: 10.1007/s11695-015-1574-1. - DOI - PubMed
    1. Felsenreich DM, Kefurt R, Schermann M, Beckerhinn P, Kristo I, Krebs M, Prager G, Langer FB. Reflux, sleeve dilation, and Barrett’s esophagus after laparoscopic sleeve gastrectomy: long-term follow-up. Obes Surg. 2017;27(12):3092–3101. doi: 10.1007/s11695-017-2748-9. - DOI - PubMed
    1. Sharma A, Aggarwal S, Ahuja V, Bal C. Evaluation of gastroesophageal reflux before and after sleeve gastrectomy using symptom scoring, scintigraphy, and endoscopy. Surg Obes Relat Dis. 2014 Jul-Aug;10(4):600–5. 10.1016/j.soard.2014.01.017. Epub 2014 Jan 28. PMID: 24837563. - PubMed

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