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Rapolti DI, Monrabal Lezama M, Manueli Laos EG, Schlottmann F, Masrur MA. Management of Gastroesophageal Reflux Disease after Sleeve Gastrectomy: Effectiveness of Medical, Endoscopic, and Surgical Therapies. J Laparoendosc Adv Surg Tech A 2024; 34:581-602. [PMID: 38568115 DOI: 10.1089/lap.2024.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024] Open
Abstract
Introduction: Sleeve gastrectomy (SG) has become the most frequently performed bariatric operation in the United States. One of the main disadvantages of this procedure is the risk of developing gastroesophageal reflux disease (GERD) after the operation. We aimed to analyze different approaches for the treatment of GERD after SG. Methods: A literature review was performed to identify all possible treatment options for post-SG GERD. All the studies were assessed for full eligibility by manual assessment of their aims, methodology, results, and conclusions. Records were individually reviewed by the authors comparing outcomes and complications between procedures. Results: Although some studies have shown improvement or even resolution of GERD symptoms after SG, most patients develop or worsen symptoms. Lifestyle modifications along with medical therapy should be started on patients with GERD after SG. For those who are refractory to medication, endoscopic and surgical therapies can be offered. Conversion to Roux-en-Y gastric bypass (RYGB) is consistently effective in treatment of GERD and is the ideal therapy in patients with associated insufficient weight loss. Endoscopic and alternative surgical procedures are also available and have shown acceptable short-term outcomes. Conclusions: Several treatment options exist for the treatment of GERD after SG. Although conversion to RYGB remains the most effective therapy, other emerging endoscopic and surgical procedures could avoid the potential morbidity of this procedure and should be further evaluated. An evidence-based algorithm for the management of GERD after SG is proposed to guide decision making.
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Affiliation(s)
- Diana I Rapolti
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
| | | | | | - Francisco Schlottmann
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Mario A Masrur
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
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Mu SZ, Saber AA. Gastroesophageal Reflux Disease and Weight Loss After Fundoplication Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2024; 34:318-329. [PMID: 38109011 DOI: 10.1007/s11695-023-06927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Fundoplication sleeve gastrectomy (FSG) is a novel bariatric procedure that combines anti-reflux fundoplication with sleeve gastrectomy (SG) to simultaneously address gastroesophageal reflux disease (GERD) and obesity. We performed a systematic review and meta-analysis to quantify the prevalence of postoperative GERD and amount of weight loss after FSG. METHODS We searched PubMed, Embase, and Web of Science Core Collection in May 2023 for full-text reports of case series, registries, cohort studies, and randomized clinical trials that reported postoperative GERD and percent excess weight loss (%EWL) after FSG for patients with preoperative GERD and obesity, excluding reports including patients with previous history of bariatric procedures. We used random effects models to estimate postoperative GERD prevalence and %EWL. Risk of bias and evidence quality were assessed with the ROBINS-I and GRADE frameworks (PROSPERO CRD42023420067). RESULTS Of the 935 records initially identified, 13 studies from 8 countries met our inclusion criteria. The prevalence of postoperative GERD pooled from 418 patients was 4.8% (95% CI: 2.8 to 8.4%). Pooled %EWL, available for 225 patients from 7 studies, was 67.8% (95% CI: 55.2 to 80.5). The overall quality of evidence was low, largely due to observational study design, lack of blinded outcome assessment, and evidence of publication bias. CONCLUSION Fundoplication sleeve gastrectomy is an emerging surgical approach for patients with obesity and GERD with promising initial outcomes. Additional studies of efficacy and safety are needed to compare FSG and its technical variations with other weight loss procedures.
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Affiliation(s)
- Scott Z Mu
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alan A Saber
- Department of Surgery, Division of Bariatric and Metabolic Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave., F4, Newark, New Jersey, 07112, USA.
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Wrap Perforation after Sleeve Gastrectomy with Posterior Fundoplication: Initial Surgery and Reoperation. Obes Surg 2023; 33:1317. [PMID: 36800159 DOI: 10.1007/s11695-023-06509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
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Manos T, Nedelcu M, Nedelcu A, Gagner M, Weiss AK, Bastid C, Carandina S, Noel P. Leak After Sleeve Gastrectomy: Updated Algorithm of Treatment. Obes Surg 2021; 31:4861-4867. [PMID: 34455540 DOI: 10.1007/s11695-021-05656-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is currently the most common procedure performed worldwide, and still the leak is considered the main limitation. After an initial enthusiasm for stents, the endoscopic treatment evolved including in the current management the septotomy with balloon dilatation and pigtails insertions. The aim of this study was to evaluate the updated algorithm of endoscopic treatment of leak following LSG including septotomy and balloon dilatation. METHODS All consecutive patients treated by endoscopy between January 2018 and March 2020 for leak following LSG were included in the current study. After recording the demographic and the leak history, we have analyzed the number of endoscopic sessions, the duration of treatment, and the healing rate of endoscopic treatment for 3 groups: A, small orifice (< 10 mm); B, large orifice (> 10 mm) and acute leak; and group C with large orifice and late leak. RESULTS A total of 53 patients received endoscopic treatment for leak following LSG. The leaks achieved complete healing after average duration of 3.2 months (range 1-7 months), 2.3 months for group A, 4.2 months for group B, and 3.7 months for group C. The average number of endoscopic procedures was 2.8 (range 2-6) and was required for general population: for group A, 2.3 sessions; in group B, 3.4 sessions; and in group C, 2.7 sessions. Two out of 53 patients (3.8%) required additional treatment outside of the current algorithm, one in group A and another in group B. One patient was transferred for pulmonary abscess, and for another patient, the leak was considered chronic after a total of 14 months, and a laparoscopic fistula-jejunostomy was performed with favorable outcomes. CONCLUSIONS Although there is still no consensus for endoscopic management of leaks after LSG, the benefits of pigtails and the septotomy are undeniable, and it should be included in the armamentarium of any bariatric endoscopic service.
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Affiliation(s)
- Thierry Manos
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France. .,ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Place du 4 Septembre, 83100, Toulon, France.
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Place du 4 Septembre, 83100, Toulon, France
| | | | - Abdul Kader Weiss
- Emirates Specialty Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Christophe Bastid
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France
| | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Place du 4 Septembre, 83100, Toulon, France
| | - Patrick Noel
- ELSAN, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France.,Emirates Specialty Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.,Mediclinic Airport Road, Abu Dhabi, United Arab Emirates
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Feng TY, Feng AC, Lin CH, Hsu FC, Wang SC, Chan DC, Chen TW, Hsu KF. Combined Nissen Fundoplication and Single Anastomosis Sleeve Ileal Bypass (N-SASI) as a Practical Modality of Bariatric Surgery (Video Report). Obes Surg 2021; 31:5104-5106. [PMID: 34403079 DOI: 10.1007/s11695-021-05670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022]
Abstract
Sleeve gastrectomy is one of the most common bariatric procedures because of its simplicity and effectiveness. Gastro-esophageal reflux disease (GERD) symptoms and weight regain after SG are common issues. Roux-en-Y gastric bypass (RYGB) is currently the most promising approach to achieve satisfying weight loss and GERD remission; however, remnant gastric cancer is still a major concern for patients. We present a video case that individualized procedure of Nissen fundoplication, and SASI bypass (N-SASI) was designed and applied to the patient with class III obesity and severe GERD. This is a 37-year-old man with obesity (BMI: 41.8 kg/m2, categorized as class III obesity) and associated disease of stage 1 hypertension, hyperlipidemia, obstructive sleep apnea syndrome, and non-alcoholic steatohepatitis as well as severe symptoms of GERD. Esophageal-gastro-duodenal scope revealed GERD grade C, hiatal hernia, and duodenal ulcer. He refused RYGB recommended initially due to serious concern about remnant gastric cancer. We therefore performed Nissen fundoplication for his GERD symptoms and adapted SASI bypass instead of RYGB as the individualized bariatric surgery to achieve the optimal surgical outcome. The postoperative course was smooth, and the patient was discharged on postoperative day 8.
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Affiliation(s)
- Ting-Yuan Feng
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
| | - An-Chieh Feng
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chien-Hua Lin
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
- IRCAD Taiwan, Department of Surgery, Chang-Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Fang-Chin Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Sheng-Chun Wang
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
| | - De-Chuan Chan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Teng-Wei Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
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