Abstract
Purpose
The development of gastroesophageal reflux disease (GERD) is a commonly encountered scenario after sleeve gastrectomy. A recently reported technical amendment to incorporate a Nissen fundoplication is discussed in this multimedia article focussing on optimising outcomes and reducing complications.
Materials and Methods
An intraoperative video has been edited to demonstrate the Nissen-Sleeve Gastrectomy and important technical considerations in its technical performance.
Results
Gastrolysis is performed proximally from 6 cm proximal to the pylorus. Routine full mediastinal mobilisation of the oesophagus (5 cm) is completed. Cruroplasty is routinely performed. A short Nissen fundoplication is completed calibrated on a 37 French bougie and then sleeve gastrectomy is performed. Our team’s experience suggests that careful manipulation of the fundus and using reproducible measurements of the fundus are key to completing the fundoplication whilst minimising complications. A control test with mobilisation of the bougie through the wrap is recommended at the end of the procedure.
Conclusion
The Nissen-Sleeve Gastrectomy, as presented in this video, is safe and has good short-term efficacy outcomes. Longer term and randomised studies are ongoing.
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References
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Contributions
DN, ACC, SJ, PB, MN and TG were involved in research design. DN, ACC, SJ and PB were involved in data acquisition. DN, ACC, SJ, PB, MN and TG were involved in data interpretation, production of the manuscript and critical revisions. All authors approved the final submitted manuscript.
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Key points
Nissen-Sleeve Gastrectomy is a safe and viable option for management of patients with severe obesity and gastroesophageal reflux disease.
Key factors to reduce complications when learning this technique include safe manipulation of the fundus and reproducible measurement of the fundus when creating the fundoplication.
Use of an orogastric bougie is recommended to standardise the cruroplasty closure and fundoplication wrap and to reduce the risk of postoperative dysphagia.
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Nocca, D., Currie, A.C., Joumaa, S. et al. A Video-Based Review of Important Technical Concepts in the Nissen-Sleeve Gastrectomy. OBES SURG 33, 1304–1306 (2023). https://doi.org/10.1007/s11695-022-06429-7
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DOI: https://doi.org/10.1007/s11695-022-06429-7