Laparoscopic Nissen Sleeve Gastrectomy for GERD and Obesity

Treating patients with both gastroesophageal reflux disease (GERD) and severe obesity can be challenging. Laparoscopic sleeve gastrectomy alone can exacerbate GERD symptoms and can induce GERD in asymptomatic patients (1). Obese patients have worse long-term control of reflux symptoms following a standalone laparoscopic fundoplication (2, 3).

The laparoscopic Nissen sleeve gastrectomy (NSG) is an effective surgical technique that combines the benefits of laparoscopic Nissen fundoplication for treating GERD with the metabolic and weight-loss benefits of sleeve gastrectomy alone (4, 5). The NSG may represent a surgical technique that can address the shortcomings of these two independent procedures by providing the weight-loss benefits of sleeve gastrectomy as well as the GERD treatment provided by fundoplication.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the typical treatment for patients pursuing bariatric surgery with GERD. NSG may represent an alternative for GERD patients who are unable to undergo a bypass procedure. Limited prospective data assessing the efficacy of NSG are available, and a randomized controlled trial is currently underway to compare NSG with Roux-en-Y gastric bypass (6).

Despite the potential benefits of NSG, the surgery may be associated with more frequent postoperative complications; therefore, meticulous surgical technique is critical (4). This video demonstrates the surgical technique of the laparoscopic NSG in treating a patient presenting with GERD and obesity.

References 

1. DuPree CE, Blair K, Steele SR, Martin MJ. Laparoscopic Sleeve Gastrectomy in Patients With Preexisting Gastroesophageal Reflux Disease: A National Analysis. JAMA surgery. 2014;149:328-334.
2. Amicucci G, Guadagni S, Pessia B, et al. Short- and Long-Term, 11-22 Years, Results after Laparoscopic Nissen Fundoplication in Obese versus Nonobese Patients. Journal of Obesity. 2017;2017:243-251.
3. Nadeem F, Singh A, Karim M, Khan A, Mirza S, Kabir SA. The Impact of Obesity on Reflux Recurrence Following Laparoscopic Anti-reflux Surgery: An Evidence-Based Systematic Review and Meta-Analysis. Cureus. 2024 Mar 26;16(3):e56981. doi: 10.7759/cureus.56981. PMID: 38665763; PMCID: PMC11045245.
4. Loo JH, Chue KM, Lim CH, et al. Effectiveness of sleeve gastrectomy plus fundoplication versus sleeve gastrectomy alone for treatment of patients with severe obesity: a systematic review and meta-analysis. Surgery for obesity and related diseases. 2024;20:532-543.
5. Maimaitiyusupu P, Aili A, Yisireyili M, Li Y, Abudureyimu K, Li X. Comparative efficacy of sleeve gastrectomy with fundoplication versus standard sleeve gastrectomy in obesity and gastroesophageal reflux disease: A randomised trial. Diabetes, obesity & metabolism. 2025.
6. ‘t Hart JWH, Noordman BJ, Biter LU, et al. Nissen-Sleeve procedure versus laparoscopic Roux-en-Y gastric bypass in patients with morbid obesity and gastro-oesophageal reflux disease: protocol for a non-inferiority randomised trial (GINSBY)BMJ Open 2022;12:e061499. doi: 10.1136/bmjopen-2022-061499

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