Nissen sleeve gastrectomy: 5-year follow-up results

Background: Nissen sleeve gastrectomy is a new bariatric procedure based on the combination of 2 well-known surgical techniques (vertical sleeve gastrectomy and Nissen fundoplication). It was conceived as a means to prevent the major drawback of the sleeve gastrectomy (SG), the gastroesophageal reflux disease (GERD), while preserving the advantages of SG in terms of weight loss, and remission of obesity-related comorbidities.

Objectives: The objectives of this study are to present the long-term (5 years) follow-up results on weight loss, evolution of GERD and other comorbidities, and the complication rate of the Nissen sleeve gastrectomy.

Setting: Montpellier University Hospital, France.

Methods: This is a prospective analysis of patients who underwent Nissen sleeve gastrectomy as a first-line bariatric procedure between January 2018 and February 2019. A subgroup analysis of patients with no further surgery during follow-up was also performed.

Results: A total of 144 patients underwent Nissen sleeve gastrectomy: After adjusting for exclusion criteria, 133 patients comprised the initial study population, 81.9% of whom had complete follow-up for weight and GERD clinical symptom outcomes at 5 years. The mean total weight loss (TWL%) was 22 (±12.3)% and the mean excess weight loss percentage (EWL%) was 59.4% (±34.2)%. Of the 63 patients with preoperative clinical symptoms of GERD, we observed an 85.5% 5-year clinical remission rate; however, only 25 patients had a gastroscopy at 5 years. The cumulative short- and long-term reoperation rate was 8.1% and the mortality rate was zero.

Conclusions: The Nissen sleeve gastrectomy achieves a satisfactory long-term TWL% and a significant improvement in comorbidities, particularly regarding the incidence of GERD. The rate of complications requiring surgical reoperation is low.