Abstract
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has rapidly become popular with excellent results. However, LSG may exacerbate or increase the risk of "de novo" gastroesophageal reflux disease (GERD). Adding a fundoplication has been proposed to increase the lower esophageal sphincter competency. The aim of this study was to examine the current evidence and outcomes of sleeve-fundoplication (Sleeve-F). MATERIALS AND METHODS: Systematic review and meta-analysis. Web of Science, PubMed, and Embase data sets were consulted. RESULTS: Six studies (485 patients) met the inclusion criteria. The age of the patient population ranged from 17 to 72 years old and 82% were females. All patients underwent sleeve-fundoplication. Rossetti, Collis-Nissen, and Nissen were the most commonly performed fundoplications. The estimated pooled prevalence of postoperative leak, gastric perforation, and overall complications were 1.0% (95% CI = 0.0-2.0%), 2.9% (95% CI = 0.0-8.3%), and 9.8% (95% CI = 6.7-13.4%), respectively. The pooled reoperation rate was 4.1% (95% CI = 1.3-10%). There was no mortality. At 12-month follow-up, the estimated pooled BMI and %EWL were 29.9 kg/m(2) (95% CI = 28.5-31.2) and 66.2% (95% CI = 59.3-71.1), respectively, while esophagitis, PPI consumption, and GERD rates were 8.0% (95% CI 3-21%), 7.8% (95% CI 5-13%), and 11% (95% CI 4-26%). CONCLUSIONS: This systematic review and meta-analysis shows that current evidence for Sleeve-F is limited with high postoperative gastric perforation and overall complication rates. Weight loss and GERD resolution seem promising in the short term; however, further studies are warranted to explore long-term effects with instrumental investigations. Sleeve-F should be considered cautiously while future well-structured randomized trials are warranted.