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TOPLINE: 

Modified laparoscopic sleeve gastrectomy with fundoplication (LSGFD) outperformed standard laparoscopic sleeve gastrectomy (LSG) in both managing body weight and reducing symptoms of gastroesophageal reflux disease (GERD) over 12 months in patients with obesity. The LSGFD group also showed greater reductions in reflux esophagitis and required less acid-suppressive medication postoperatively.

METHODOLOGY:

• GERD frequently occurs in patients with obesity and is characterized by acid reflux, leading to heartburn and retrosternal pain. Although traditional LSG results in substantial weight loss, it can worsen reflux, so modified LSGFD was developed to preserve the gastric fundus and manage GERD.
• Researchers conducted a prospective randomized controlled trial to compare the efficacy of modified LSGFD vs standard LSG for weight loss and managing GERD in patients with obesity who had mild-to-moderate GERD.
• They enrolled 80 patients of Asian ethnicity with obesity (BMI ≥ 32.5) or overweight and comorbidities (BMI ≥ 27.5) and randomly assigned them to undergo LSGFD (n = 27) or LSG (n = 53).
• Primary outcomes encompassed weight-related indicators (body weight, BMI, and percentage of excess weight loss) and GERD-related measures (GERD questionnaire score, lower esophageal sphincter pressure, etc); assessments were conducted at baseline and 6 and 12 months postoperatively.

TAKEAWAY:

• At 6 and 12 months postoperatively, the LSGFD group achieved significantly greater reductions in body weight than the LSG group (P < .05 for both). The percentage of excess weight loss was also greater in the LSGFD group than in the LSG group at 12 months.
• The GERD questionnaire score decreased while the lower esophageal sphincter pressure increased in the LSGFD group at both 6 and 12 months after surgery, whereas the LSG group showed no meaningful change in either measure at any postoperative timepoint.
• The LSGFD group experienced greater postoperative reductions in obesity-related comorbidities (reflux esophagitis, hiatal hernia, diabetes, and hypertension) and a reduced need for acid-suppressive medication compared with the LSG group.

IN PRACTICE:

“By simultaneously addressing obesity and reflux, LSGFD offers a more comprehensive solution and avoids the potential exacerbation of GERD often seen after standard LSG,” the authors wrote.

SOURCE:

The study was led by Pierdiwasi Maimaitiyusupu, MD, Research Institute of General and Minimally Invasive Surgery, Urumqi, Xinjiang Uygur Autonomous Region (XUAR), China. It was published online in Diabetes, Obesity and Metabolism.

LIMITATIONS: 

The study was limited by its relatively small sample size, short 12-month follow-up period, and single-center design. Additionally, the exclusive focus on an Asian population restricted the generalizability of the findings to other ethnic and geographic groups. 

DISCLOSURES:

The study was supported by the National Natural Science Foundation of China, the Tianchi Hundred People Project for Introducing High-Level Talents in the XUAR, and the Special Project for Key R&D Tasks of the XUAR. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.