IBC Oxford University Oral Abstract 5 - The role of fundoplication sleeve gastrectomy in obesity surgery: a systematic review and meta-analysis

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Abstract Introduction Fundoplication Sleeve Gastrectomy (FSG) is a new bariatric procedure that was proposed as an alternative to the standard sleeve gastrectomy (SG), which is associated with an increase in the incidence and prevalence of gastroesophageal reflux disease (GERD). This systematic review and meta-analysis aimed to assess the current evidence on this new surgical procedure in terms of weight loss, prevalence of GERD after the bariatric procedure and postoperative complications. Methods Following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) recommendations, we conducted a systematic review and meta-analysis by searching three databases (PubMed, Scopus, and Web of Science). We performed a meta- analysis of relative risks to compare FSG and SG for postoperative prevalence of GERD and postoperative complications. Heterogeneity was assessed using I2 statistic. Results Fourteen articles were included in the qualitative synthesis and 3 in the quantitative synthesis (meta-analysis). Weight loss was assessed through percentage of excess weight loss (%EWL) in 9 studies from the qualitative synthesis and %EWL at 12 months follow-up ranged between 58 ± 23% and 83.3 ± 28.5%. The comparison between FSG and SG showed no statistically significant difference (RR = 0.36; 95%c.i. [0.13; 1.03]; P = 0.056) regarding postoperative prevalence of GERD. However, a trend indicating a lower risk of postoperative GERD after FSG was observed. Regarding postoperative complications, there was no significant difference between the two approaches (RR = 1.53; 95%c.i. [0.67; 3.49]; P = 0.314). Conclusion Our systematic review and meta-analysis reported encouraging results concerning weight loss, GERD symptoms after surgery and postoperative complications after FSG, however, current evidence is still limited. Additional standardized studies, comparing FSG to other bariatric procedures and directly comparing different types of FSG are needed.

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