Vertical Sleeve Gastrectomy (VSG), commonly known as the Gastric Sleeve, gained traction as a standalone surgery in the early 2000s and has since become the most popular bariatric procedure worldwide. However, a notable drawback is its potential to trigger or worsen Gastroesophageal Reflux Disease (GERD) and acid reflux, especially in patients with pre-existing conditions.

Approximately 35% of gastric sleeve patients experience new or worsened GERD symptoms postoperatively, which can significantly impact quality of life.1

The good news is that adding a fundoplication—a procedure that strengthens the lower esophageal sphincter (LES)—can effectively “rescue” the VSG, helping to control or resolve those bothersome reflux symptoms.

How Gastric Sleeve Affects Reflux

While gastric sleeve surgery helps with weight loss, it can increase the risk of acid reflux. Removing most of the stomach and reshaping it into a narrow tube raises internal pressure and may weaken the LES, making reflux more likely.

Although lifestyle and dietary modifications can help control reflux, laparoscopic anti-reflux surgery, such as Nissen Fundoplication, offers a more definitive solution for long-term relief.

What is Fundoplication?

Fundoplication is a surgical procedure in which the fundus (upper part of the stomach) is wrapped around the lower esophagus to reinforce the lower esophageal sphincter (LES). This prevents acid reflux and corrects hiatal hernias, which are often associated with gastroesophageal reflux disease (GERD).2

Fundoplication with Gastric Sleeve Surgery

Can Fundoplication Be Combined with Gastric Sleeve?

Although the gastric sleeve and fundoplication are typically separate procedures, they can be combined into a single operation to prevent the worsening of GERD while achieving weight loss.

  • The fundus is wrapped around the esophagus to reduce reflux.
  • The gastric sleeve is then created around the existing fundoplication, which avoids damage to the wrap and supports effective weight loss.

Who Should Consider Fundoplication with Gastric Sleeve?

This combined approach is especially beneficial for patients who:

  • You’re obese and also suffer from chronic acid reflux
  • You have a hiatal hernia or Barrett’s esophagus
  • You’re seeking a non-bypass alternative for GERD and weight loss
  • You’ve been told a traditional gastric sleeve may worsen your reflux

Who Should Consider Fundoplication with Gastric Sleeve

How Effective is Fundoplication with Gastric Sleeve?

Clinical studies have shown that combining fundoplication with the gastric sleeve can significantly reduce GERD symptoms and improve quality of life, particularly in the short to mid-term. One 2020 study reported that only 13% of patients experienced minor complications, with most issues resolved through conservative treatment.

Conclusion

Fundoplication combined with the gastric sleeve is a valuable surgical option for patients with acid reflux or GERD.

Consultation with a specialized bariatric surgeon is crucial to determine the best treatment plan, especially for patients with pre-existing reflux or hiatal hernias. Find out if you’re a candidate for the gastric sleeve with fundoplication and get approved within 24-48 hours.

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