Laparoscopic Nissen Fundoplication with Gastric Plication as a Potential Treatment of Morbidly Obese Patients with GERD, First Experience and Results

Lee, Wei-Jei; Han, Ming-Lun; Ser, Kong-Han; Tsou, Ju-Juin; Chen, Jung-Chien; Lin, Chia-Hsien
September 2014
Obesity Surgery;Sep2014, Vol. 24 Issue 9, p1447
Academic Journal
Background: Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease (GERD). However, there is no consensus for the surgical treatment of GERD in morbidly obese patients. Methods: Twenty-five morbidly obese patients with GERD underwent our novel procedure, laparoscopic Nissen fundoplication with gastric plication (LNFGP), and were monitored for 6 to 18 months. Operative complication, weight loss, and GERD symptoms were monitored. Results: The study subjects consisted seven males and 18 females. The average age was 38.2 years (from 18 to 58), and the mean BMI was 37.9 kg/m (from 31.5 to 56.4). The mean operative time was 145.6 min (from 105 to 190). All procedures were performed via laparoscopic surgery. Two patients (8 %) displayed a major 30-day perioperative complication. The first patient had an acute leak on the second postoperative day. The patient received a laparoscopic revision sleeve gastrectomy and was discharged 5 days later after an uneventful recovery. Another patient developed an intra-abdominal abscess 3 weeks after surgery and received laparoscopic drainage and a revision sleeve gastrectomy. Upon follow-up, only four (16 %) patients experienced occasional acid regurgitation symptoms; however, no anti-acid medication was required. A significant decrease in the prevalence of erosive esophagitis (80 vs. 17 %) after LNFGP was observed. The mean weight loss was 9.7, 14.1, 17.9, and 18.1 % at 1, 3, 6 and 12 months, respectively. The mean BMI decreased to 30.8 kg/m 1 year post surgery with a mean body weight loss of 25 kg. Conclusions: LNFGP appears to be an acceptable treatment option for treating GERD in morbidly obese patients who refuse Roux-en-Y gastric bypass. However, further study is indicated to verify this novel procedure.


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