Balancing GERD improvement and higher morbidity: a multicenter cohort study of Nissen sleeve gastrectomy versus standard sleeve gastrectomy

Background: Sleeve gastrectomy (SG) is often associated with de novo or worsened postoperative gastroesophageal reflux disease (GERD). Nissen-SG, which combines SG with an antireflux fundoplication, has been proposed to reduce postoperative GERD. The objective of this study was to evaluate the early postoperative morbidity of Nissen-sleeve gastrectomy (Nissen-SG) in comparison with SG. Materials and methods: This retrospective multicenter study included patients who underwent Nissen-SG in 14 French centers (2019–2024). Data on postoperative complications were collected from medical records. These patients were matched (1:3 ratio) on propensity score with those who underwent SG in the same center between 2019 and 2024, identified using the French national healthcare database. Thirty-day severe complications (Clavien–Dindo ≥3) were compared between groups. Results: A total of 380 Nissen-SG patients (mean age 39.6 ± 11.6 years, 86.1% females) were included. Valve dilatation, stenosis, necrosis and perforation within 30 days after surgery accounted for 2.3%, 1.8%, 0.5%, and 1.8%, respectively. A matched cohort of 1140 SG patients was identified. Severe complications were significantly more frequent with Nissen-SG (7.9 vs 3.9%, P = 0.002), without statistically significant differences for fistula or peritonitis. Nissen-SG was independently associated with severe complications in multivariate analysis (OR: 2.22; 95%CI: 1.45–3.28). Conclusion: This large multicenter study suggests that the benefits regarding GERD after Nissen-SG should be balanced with postoperative complication rates. More prospective randomized studies are needed to provide guidelines for surgical decision-making in specific cases.