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Sleeve Gastrectomy and Anterior Fundoplication (D-SLEEVE) Prevents Gastroesophageal Reflux in Symptomatic GERD

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A Correction to this article was published on 04 February 2021

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Abstract

Background

A worrying increase of gastroesophageal reflux disease (GERD) and Barrett esophagus has been reported after sleeve gastrectomy (SG). Recent reports on combined fundoplication and SG seem to accomplish initial favorable results. However, no study included manometry or pH monitoring to evaluate the impact of fundoplication in SG on esophageal physiology.

Method

In this study, 32 consecutive bariatric patients with GERD and/or esophagitis had high-resolution impedance manometry (HRiM) and combined 24-h pH and multichannel intraluminal impedance (MII-pH) before and after laparoscopic sleeve gastrectomy associated to anterior fundoplication (D-SLEEVE). The following parameters were calculated at HRiM: lower esophageal sphincter pressure and relaxation, peristalsis, and mean total bolus transit time. The acid and non-acid GER episodes were assessed by MII-pH, symptom index association (SI), and symptom-association probability (SAP) were also analyzed.

Results

At a median follow-up of 14 months, HRiM showed an increased LES function, and MII-pH showed an excellent control of both acid exposure of the esophagus and number of reflux events. Bariatric outcomes (BMI and EWL%) were also comparable to regular SG (p = NS).

Conclusion

D-SLEEVE is an effective restrictive procedure, which recreates a functional LES pressure able to control and/or prevent mild GERD at 1-year follow-up.

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Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Change history

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Authors and Affiliations

  1. Center of Esophago-gastric and Obesity Surgery (E.G.O.), XI Division and Bariatric Surgery, University Vanvitelli, Naples, Italy

    Gianmattia del Genio, Salvatore Tolone, Claudio Gambardella, Luigi Brusciano, Mariachiara Lanza Volpe, Giorgia Gualtieri, Federica del Genio & Ludovico Docimo

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  1. Gianmattia del Genio
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  2. Salvatore Tolone
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Correspondence to Gianmattia del Genio.

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Informed consent was obtained from all individual participants included in the study.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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del Genio, G., Tolone, S., Gambardella, C. et al. Sleeve Gastrectomy and Anterior Fundoplication (D-SLEEVE) Prevents Gastroesophageal Reflux in Symptomatic GERD. OBES SURG 30, 1642–1652 (2020). https://doi.org/10.1007/s11695-020-04427-1

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