Laparoscopic Sleeve-Collis-Nissen Gastroplasty: a Safe Alternative for Morbidly Obese Patients with Gastroesophageal Reflux Disease

Some studies have recently suggested that laparoscopic sleeve gastrectomy may exacerbate gastroesophageal reflux disease (GERD) symptoms or even increase the risk of de novo post-operative GERD. We herein describe and evaluate the initial response of an alternative technique of sleeve gastroplasty combined with Nissen fundoplication for morbidly obese patients who present significant GERD. From January 2008 to December 2013, 122 morbidly obese patients underwent laparoscopic Sleeve-Collis-Nissen gastroplasty (LSCNG). The great majority of the patients were female (97.5 %), with a mean age of 42.4 years old (from 18 to 72). Hiatal hernia and use of proton pump inhibitors (PPIs) were presented in 54.9 and 92 %, respectively. The mean operative time was 91 +/- 6 min. The mean hospitalization stay was 2 +/- 0.3 days. Major complications including stenosis requiring endoscopic dilation and GI bleeding were observed in five patients (4.1 %). No leaks were observed. One-year follow-up showed a significant decrease in the prevalence of esophagitis (100 vs 13.6 %) and the use of PPIs (92 vs 13.6 %). The percentages of excess weight loss 1 and 3 years after the surgery were 64.4 +/- 7.2 and 60.4 +/- 8.1 %, respectively. LSCNG is a novel, technically feasible surgery with a low incidence of procedure-related complications. However, further prospective studies are required to assess the real impact of this procedure on the improvement of GERD symptoms.