# Gastric greater curvature plication combined with Nissen fundoplication compared to sleeve gastrectomy in patients with obesity and animal model

## TL;DR

This study compares two weight loss surgeries in people with obesity and finds that sleeve gastrectomy is more effective for weight and glucose improvement, though another procedure prevents acid reflux better.

## Contribution

The study provides a direct comparison of gastric plication plus fundoplication versus sleeve gastrectomy in both human patients and animal models.

## Key findings

- Sleeve gastrectomy outperformed gastric plication plus fundoplication in weight loss and glucose tolerance in both humans and rats.
- Gastric plication plus fundoplication resolved acid reflux completely in patients, while sleeve gastrectomy caused new reflux symptoms.
- Both procedures improved insulin sensitivity and secretion in diabetic rats.

## Abstract

Gastric greater curvature plication combined with Nissen fundoplication (GGCP + Nissen) has been previously performed, but its efficacy remains uncertain.

A single-center retrospective review was conducted on patients with obesity who underwent GGCP + Nissen or sleeve gastrectomy (SG) between January 2016 and December 2022. Both groups were matched for age, gender, and baseline BMI. In the animal experiments, GGCP + Nissen, SG, and sham procedures were performed on Goto-Kakizaki rats, a model of normal-weight rats with T2DM.

A total of 75 patients were included in this study, of whom 35 underwent GGCP + Nissen, and 40 underwent SG. Both groups were matched for age, gender, and baseline BMI. The percent total weight loss (%TWL) in the GGCP + Nissen and SG groups were 16.38 ± 3.69 and 25.05 ± 7.24 at 6 months (P < 0.05), 16.40 ± 4.96 and 26.85 ± 9.13 at 12 months (P < 0.05), and 12.46 ± 5.90 and 24.57 ± 8.61 at 24 months (P < 0.05), respectively. However, all 8 patients with preoperative reflux in the GGCP + Nissen group achieved complete resolution of symptoms postoperatively, whereas in the SG group, 10 patients developed new-onset reflux at 1 month, with 4 continuing to experience persistent symptoms at 24-month follow-up. In the animal experiments, both GGCP + Nissen and SG induced significant weight loss and improved glucose tolerance, with rats showing increased insulin sensitivity and secretion. However, the SG group performed better than the GGCP + Nissen group in terms of both weight loss and improvement of glucose tolerance.

GGCP + Nissen was inferior to SG both in weight loss and improvement of glucose tolerance, although GGCP + Nissen could lead a substantial weight loss and improve GERD efficiently.