A study was designed to compare the effect of sleeve gastrectomy (SG) with SG along with Rossetti fundoplication (SG + RF) on de novo gastro-esophageal reflux disease (GERD) following surgery, weight loss, and postoperative complications.

Patients with morbid obesity, who had no symptoms of GERD, and had never received treatment with proton pump inhibitors (PPIs), were randomized into two groups - One group was subjected to SG and the other to SG + RF. The study was stopped in February 2020 due to the COVID-19 pandemic.

Overall, 278 patients of the programed number of 404 patients were recruited in the study (68.8%). De novo esophagitis was considered in patients who had both pre- and postoperative gastroscopy (97/278). A total of 251 patients (90.3%) completed the clinical follow-up at 12 months.

• SG + RF intervention led to an adequate weight loss, similar to SG at 12-month follow-up (%TWL = 35. 4 ± 7.2%) with a significantly better outcome with regard to GERD development.
• One year following surgery, PPIs were required in 4.3% patients who had undergone SG + RF, compared to 17.1% of SG patients (p = 0.001).
• Esophagitis was noted in 2% of SG + RF patients compared to 23.4% of SG patients (p = 0.002).
• The major complication after SG + RF was wrap perforation (4.3%), which appeared to improve with the surgeons learning curve.

To conclude, SG + RF is an effective alternative to classic SG for the prevention of de novo GERD.

More studies are required to confirm that an adequate learning curve tends to reduce the higher percentage of short-term complications with SG + RF.

Source: Olmi S, Cesana G, Gambioli A, et al. 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. Obes Surg. 2022 Feb 8.