title: Nissen Sleeve (N-Sleeve) operation: preliminary results of a pilot study.
abstract: BACKGROUND
  Sleeve gastrectomy (SG) is one of the most frequently performed bariatric procedures worldwide. Despite its impressive results, there is a growing concern about the relationship between SG and gastroesophageal reflux disease (GERD).
  
  
  OBJECTIVE
  We present our pilot study of patients operated with a Nissen anti-reflux valve added to a standard SG.
  
  
  METHODS
  University hospital in Montpellier, France.
  
  
  METHODS
  A prospective monocentric study including 25 consecutive patients operated with a laparoscopic Nissen-Sleeve (N-Sleeve) gastrectomy was carried out between September 2013 and March 2014. Inclusion criteria were indication for bariatric surgery for patients with GERD (Montreal's definition and classification). All patients were followed postoperatively for 1 year.
  
  
  RESULTS
  There were 13 (54%) females and 12 (46%) males with mean age of 41±12 (20-65) years. Mean body mass index was 42±4.8 (35-53) kg/m2. Preoperatively, all patients had esophageal syndromes. Twenty-three (92%) patients had typical symptoms of GERD, but 2 were asymptomatic; however, they had esophageal injury. Esophagitis grade I-III presented in 10 (40%) patients and Barrett's esophagus in 8 (32%) cases. Two (8%) patients also had extraesophageal syndrome represented by asthma. Nineteen (76%) patients previously took proton pump inhibitors, regularly and 22 (88%) had experienced a hiatal hernia. There was no conversion to the open technique. Operative time was 84±13 (54-106) minutes. There were no deaths. Complications included one case of staple line bleeding and one Nissen valve perforation without recognized ischemia. No staple line failure was observed. Three months after N-Sleeve, 19 (76%) patients remained asymptomatic without proton pump inhibitor use. At 6 months and 1 year, 3 (12%) patients were still experiencing reflux. Excess weight loss at 1 year was 58±23%, total weight loss was 27±10%, and body mass index change was -11±4 kg/m².
  
  
  CONCLUSIONS
  The N-Sleeve seems to be a safe procedure that provides an adequate reflux control with no clear interference on the expected bariatric results of a standard SG.
authors.affiliation: CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France.
authors.forename: David
authors.initials: D
authors.lastname: Nocca
authors.affiliation: CHU de Montpellier, Montpellier, France.
authors.forename: El Mehdi
authors.initials: EM
authors.lastname: Skalli
authors.affiliation: CHU de Montpellier, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Boulay
authors.affiliation: CHU de Montpellier, Montpellier, France.
authors.forename: Marius
authors.initials: M
authors.lastname: Nedelcu
authors.affiliation: CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Michel Fabre
authors.affiliation: CHU de Montpellier, Montpellier, France; University Montpellier 1, Montpellier, France; Universidade Positivo, Curitiba, Brazil. Electronic address: mpailoureiro@gmail.com.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Loureiro
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D061646:Operative Time; D010865:Pilot Projects; D011182:Postoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bariatric surgery; Fundoplication; Gastrectomy; Gastroesophageal reflux; Morbid obesity