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Significant Weight Loss after Laparoscopic Nissen Fundoplication
Hassan Aliakbarian, MD; Eric Sheu, PhD, MD; Ali Tavakkoli, MD, (PI)
Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Background: With obesity reaching epidemic proportions worldwide, there is a need for new safe, minimally invasive treatments. A prior study noted weight loss after laparoscopic Nissen fundoplication (LNF) for gastroesophageal reflux disease, which involves mechanical manipulation of the gastric fundus as well as the short gastric vessels ligation. To confirm that and understand the mechanism, we compared the weight loss effect of LNF and laparoscopic splenectomy (LSP), where only short gastric vessels are ligated.

Methods: Retrospective analysis of patients at the BWH underwent LNF or LSP 2003-2013. Exclusion criteria included co-existing malignancy, prior or subsequent bariatric surgery, and post-op dysphagia requiring dilation. Weights at baseline and up to 2 yrs were collected.

Results: We identified 109 LNF and 37 LSP cases that met inclusion criteria. %BWL at 2 years was 5.71.1% for LNF (mean 9.21.8 lbs) (p value<0.01), but not significant at 0.52.2% in LSP group (mean 2.64.8 lb).

Conclusion: LNF but not LSP results in long term weight loss, suggesting weight loss after LNF is related to manipulation of the gastric fundus and not ligation of the short gastrics. Targeting the function of the gastric fundus with minimally invasive approaches may be a promising avenue for obesity therapy.

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