Background

Sleeve gastrectomy is the most commonly performed metabolic surgery in the United States but one of its limitations is the potential worsening of gastroesophageal reflux disease (GERD). Sleeve gastrectomy with fundoplication is a novel procedure that addresses both obesity and GERD, and now several centers have reported their results.

Methods

We performed a systematic review of articles describing outcomes after sleeve gastrectomy with concurrent fundoplication in three electronic databases: MEDLINE (Pubmed), Embase and Web of Science. We included original investigations including case series, prospective or retrospective cohort studies, and randomized controlled trials and excluded abstracts, case reports, technical descriptions of procedures and systematic reviews. We used random-effects meta-analysis models to estimate the pooled percent reduction in excess body weight (%EBWL) and the proportion of individuals free from GERD after the operation.

Results

We identified 811 articles in our initial search, and after removing duplicates and screening the titles and abstracts, we reviewed 51 full text articles. Post-operative GERD data was available for all 13 studies (740 patients), and percent excess body weight loss was available in 7 studies (547 patients). 95.4% (95% CI: 92.9%-97.1%) of patients were free from GERD post-operatively, and the mean percent excess body weight loss was 66.3% (95% CI: 53.8%-78.8%).

Conclusions

Sleeve gastrectomy performed with concurrent fundoplication is an emerging surgical approach for patients with obesity and GERD. Additional studies of efficacy and safety are needed to compare different gastrectomy fundoplication techniques with other weight loss procedures.