Sleeve Gastrectomy with Fundoplication in Patients with Gastroesophageal Reflux Disease: A Prospective Observational Study with 5-Year Follow-Up

INTRODUCTION: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure worldwide. However, the development or persistence of gastroesophageal reflux disease (GERD) remains a significant concern, particularly in patients with preexisting reflux symptoms. In selected bariatric patients affected by symptomatic GERD, alternative surgical strategies may be required. This prospective observational study aimed to evaluate the long-term outcomes of SG combined with Rossetti fundoplication (SGRF) in a selected population of patients with morbid obesity and documented GERD. METHODS: Patients with obesity and preoperative GERD symptoms, chronic proton pump inhibitor (PPI) use, and endoscopic evidence of esophagitis were prospectively enrolled, underwent SGRF, and were followed for more than 5 years. Unlike SG combined with Nissen fundoplication, the Rossetti technique requires a smaller portion of the gastric fundus to construct the antireflux wrap. This aspect may be particularly relevant in bariatric surgery, as SG is based on the resection of most of the gastric fundus, which contains ghrelin-producing orexigenic cells. RESULTS: In total, 38 out of 58 patients enrolled (65.5%) completed long-term follow-up (mean 68.5 months). Of all, 92.1% of patients had discontinued PPIs and reported resolution of reflux symptoms. Among the 24 patients who underwent long-term gastroscopy, 96.6% showed no evidence of esophagitis. The adjusted total weight loss (%TWL) was 26.1%. CONCLUSION: These findings suggest that SGRF may represent a promising surgical option for carefully selected bariatric patients with GERD. Further prospective studies, including objective functional assessments such as esophageal manometry and pH monitoring, are needed to better define the role of this technique.