Comparative 3-year Study of Nissen-sleeve vs. Sleeve Plus Cruroplasty in Obese Patients With Hiatal Hernia
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Ph-measurement, Questionnaires, gastroduodenal transit.
- Who it may be relevant to
- Registry conditions: Obesity, Hiatal Hernia. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- France
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
The success of laparoscopic sleeve gastrectomy (LSG) is not only due to its proven efficacy in the treatment of obesity and associated to comorbidities in the short and long term, but also because it is considered as less technically complicated compared to other malabsorptive procedures. Unfortunately, the main long-term side effect of LSG appears to be the development of severe gastroesophageal reflux (GERD). This problem is aggravated by the concomitant presence of a hiatal hernia at the time of surgery. Indeed, by causing laxity of the lower esophageal sphincter (LES), the hiatal hernia reduces the barrier functions of the esophageal-gastric junction against the reflux of gastric contents. The classic combination of sleeve and hiatal hernia treatment by cruroplasty gives contradictory results and several surgeons prefer to perform only the sleeve without addressing the hiatal hernia especially if it is small (\<4 cm). For this reason a modification of the usual surgical technique of LSG has been proposed by adding a Nissen fundoplication-Nissen Sleeve (NS). The intentions of this technique were to minimize the rate of postoperative GERD especially for patients with hiatal hernia, to protect the staple line of the angle of His, and finally to provide a safe and effective alternative for patients with a contraindication to LRYGB due to GERD. Although the first results of the technique are encouraging, the realization of the Nissen valve remains a sensitive technical point that can transform a relatively simple procedure like LSG into a more complex procedure like NS. The only test able to directly identify and classify gastric reflux is pH-metry with or without esophageal manometry. Unfortunately, especially due to the difficulty of access to the examination, there are no studies with solid scientific bases that identify the correct conduct to adopt in the case of an obese patient with a hiatal hernia (with or without preoperative reflux). The main objective of this study is to evaluate the occurence or worsening of GERD at 3 years following a Nissen-sleeve vs. sleeve plus cruroplasty intervention in patients with obesity and hiatal hernia.
Interventions
- Diagnostic test Ph-measurement
Ph measurement before and after the surgery - Other Questionnaires
GERD-HRQL Reflux symptom index scale before and after surgery - Diagnostic test gastroduodenal transit
Imaging test that uses the properties of X-rays - after the administration of a radiopaque contrast agent (usually barium) - to visualize the upper digestive tract: the esophagus, stomach, and duodenum (the upper segment of the small intestine).
Primary outcome measures
- Appearance of GERD 3 years after surgery. [Time frame: 3 years]
- Worsening of GERD 3 years after surgery. [Time frame: 3 years]
Eligibility criteria
Inclusion criteria
- Adult patient,
- Patient with severe obesity (BMI >35) with comorbidity or morbidity (BMI >40),
- Patient awaiting a sleeve gastrectomy,
- Patient with a hiatal hernia <or= 4 cm,
- Patient having undergone a gastroscopy,
- Patient having undergone an esophagogastroduodenal transit (OGDT),
- Patient having been informed and having given their free, informed and written consent,
- Patient affiliated with or beneficiary of a social security scheme.
Exclusion criteria
- Patient with poorly controlled diabetes,
- Patient with major esophageal motility disorders,
- Patient with a Hiatal Hernia > 4cm,
- History of bariatric surgery, history of ring,
- Patient refusing pH-metry examination,
- Refusal to participate in the study,
- Patient under legal protection,
- Patient not benefiting from health protection,
- Protected patient: adult under guardianship, curatorship or other legal protection, deprived of liberty by judicial or administrative decision.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Open label
- Primary purpose
- Other
Study locations
France · 1 center
- Clinique Saint Michel — Toulon
Identifiers
NCT: NCT06835790 · 2024-A00367-40