The Nissen-Sleeve (N-Sleeve): Results of a Cohort Study
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ORIGINAL CONTRIBUTIONS
The Nissen-Sleeve (N-Sleeve): Results of a Cohort Study Imed Ben Amor 1,2,3 & Vincent Casanova 1 & Geoffroy Vanbiervliet 4 & Jean Marc Bereder 5 & Richard Habitan 6 & Radwan Kassir 7 & Jean Gugenheim 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The Montpellier bariatric team has recently proposed some technical alternatives to decrease the rate of gastroesophageal reflux disease (GERD) after bariatric surgery and also to offer patients an alternative in case of contraindication to Roux-en-Y gastric bypass (RYGBP): the Nissen-Sleeve (N-Sleeve). Objectives We present here the results from a cohort of patients that underwent an operation with this newly designed anti-reflux bariatric procedure N-Sleeve: Nissen valve added to a standard SG. Methods Data from a prospective, observational, and monocentric cohort. All consecutive patients presenting to the bariatric surgery department for a laparoscopic sleeve gastrectomy between 2016 and 2018 with GERD were included in the study. The fundus was stapled with a margin from the valve, and the valve was created with tissue at a distance from the greater curvature so as to avoid a double layer stapling of the stomach. Results A total of 70 patients were included in the study. Ninety percent of the cohort presented with a hiatal hernia at the time of surgery. No mortality was observed during the follow-up period. Concerning GERD, 76% of all patients had preoperative esophageal syndromes, whereas 21% were asymptomatic with associated esophagitis. Grade A–C esophagitis was present in 99% of the cohort, but no Barrett’s esophagus was present. Fifty-six (80%) patients used PPIs regularly. At 1 year of follow-up, one patient was still symptomatic. Conclusions Comparative trials remain necessary between N-Sleeve and standard bariatric procedures to refine the specific indications of each of them and determine the eventual role of the N-Sleeve. Keywords Surgical technique . Nissen-Sleeve . N-Sleeve . Roux-en-Y gastric bypass . Sleeve gastrectomy
Introduction
* Imed Ben Amor [email protected] 1
Department of Bariatric Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
2
Université nice Sophia Antipolis, Nice, France
3
IRCAN; Unité INSERM 1081, Nice, France
4
Department of Gastroenterology, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
5
Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
6
Department of Digestive Surgery, Casablanca, Morocco
7
Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, Paris, France
Laparoscopic sleeve gastrectomy (SG) has become one of the most popular bariatric procedures in the world [1–4]. In France, more than 27,500 SGs were performed in 2014 [5]. This operation consists in removing 70 to 80% of the stomach, sparing the lesser curvature along with the pylorus. Several factors have contributed to its increasing popularity including minimal ch
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