Abstract：
BACKGROUND: Fundoplication sleeve gastrectomy (FSG) is a novel bariatric procedure that combines anti-reflux fundoplication with sleeve gastrectomy (SG) to simultaneously address gastroesophageal reflux disease (GERD) and obesity. We performed a systematic review and meta-analysis to quantify the prevalence of postoperative GERD and amount of weight loss after FSG.
METHODS: We searched PubMed, Embase, and Web of Science Core Collection in May 2023 for full-text reports of case series, registries, cohort studies, and randomized clinical trials that reported postoperative GERD and percent excess weight loss (%EWL) after FSG for patients with preoperative GERD and obesity, excluding reports including patients with previous history of bariatric procedures. We used random effects models to estimate postoperative GERD prevalence and %EWL. Risk of bias and evidence quality were assessed with the ROBINS-I and GRADE frameworks (PROSPERO CRD42023420067).
RESULTS: Of the 935 records initially identified, 13 studies from 8 countries met our inclusion criteria. The prevalence of postoperative GERD pooled from 418 patients was 4.8% (95% CI: 2.8 to 8.4%). Pooled %EWL, available for 225 patients from 7 studies, was 67.8% (95% CI: 55.2 to 80.5). The overall quality of evidence was low, largely due to observational study design, lack of blinded outcome assessment, and evidence of publication bias.
CONCLUSIONS: Fundoplication sleeve gastrectomy is an emerging surgical approach for patients with obesity and GERD with promising initial outcomes. Additional studies of efficacy and safety are needed to compare FSG and its technical variations with other weight loss procedures.
METHODS: We searched PubMed, Embase, and Web of Science Core Collection in May 2023 for full-text reports of case series, registries, cohort studies, and randomized clinical trials that reported postoperative GERD and percent excess weight loss (%EWL) after FSG for patients with preoperative GERD and obesity, excluding reports including patients with previous history of bariatric procedures. We used random effects models to estimate postoperative GERD prevalence and %EWL. Risk of bias and evidence quality were assessed with the ROBINS-I and GRADE frameworks (PROSPERO CRD42023420067).
RESULTS: Of the 935 records initially identified, 13 studies from 8 countries met our inclusion criteria. The prevalence of postoperative GERD pooled from 418 patients was 4.8% (95% CI: 2.8 to 8.4%). Pooled %EWL, available for 225 patients from 7 studies, was 67.8% (95% CI: 55.2 to 80.5). The overall quality of evidence was low, largely due to observational study design, lack of blinded outcome assessment, and evidence of publication bias.
CONCLUSIONS: Fundoplication sleeve gastrectomy is an emerging surgical approach for patients with obesity and GERD with promising initial outcomes. Additional studies of efficacy and safety are needed to compare FSG and its technical variations with other weight loss procedures.
摘要：
背景：胃底折叠袖状胃切除术（FSG）是一种新型的减肥手术，将抗反流胃底折叠术与袖状胃切除术（SG）相结合，可同时解决胃食管反流病（GERD）和肥胖症。我们进行了系统评价和荟萃分析，以量化术后GERD的患病率和FSG后体重减轻的量。
方法：我们搜索了PubMed，Embase,和2023年5月的WebofScience核心合集，用于案例系列的全文报告，登记册，队列研究，和随机临床试验，报道术后GERD和FSG后体重下降百分比（％EWL）为术前GERD和肥胖患者，排除包括既往有减肥手术史的患者在内的报告.我们使用随机效应模型来估计术后GERD患病率和%EWL。使用ROBINS-I和GRADE框架（PROSPEROCRD42023420067）评估偏倚风险和证据质量。
结果：在最初确定的935条记录中，来自8个国家的13项研究符合我们的纳入标准。418例患者术后合并GERD的患病率为4.8%(95%CI:2.8-8.4%)。汇集的%EWL，来自7项研究的225名患者，为67.8%（95%CI：55.2至80.5）。总体证据质量较低,主要是由于观察性研究设计，缺乏盲目的结果评估，和发表偏见的证据。
结论：胃底折叠袖状胃切除术是一种新兴的肥胖和GERD患者的手术方法，具有良好的初始结果。需要对疗效和安全性进行其他研究，以比较FSG及其技术变化与其他减肥程序。
方法：我们搜索了PubMed，Embase,和2023年5月的WebofScience核心合集，用于案例系列的全文报告，登记册，队列研究，和随机临床试验，报道术后GERD和FSG后体重下降百分比（％EWL）为术前GERD和肥胖患者，排除包括既往有减肥手术史的患者在内的报告.我们使用随机效应模型来估计术后GERD患病率和%EWL。使用ROBINS-I和GRADE框架（PROSPEROCRD42023420067）评估偏倚风险和证据质量。
结果：在最初确定的935条记录中，来自8个国家的13项研究符合我们的纳入标准。418例患者术后合并GERD的患病率为4.8%(95%CI:2.8-8.4%)。汇集的%EWL，来自7项研究的225名患者，为67.8%（95%CI：55.2至80.5）。总体证据质量较低,主要是由于观察性研究设计，缺乏盲目的结果评估，和发表偏见的证据。
结论：胃底折叠袖状胃切除术是一种新兴的肥胖和GERD患者的手术方法，具有良好的初始结果。需要对疗效和安全性进行其他研究，以比较FSG及其技术变化与其他减肥程序。
