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Related Experiment Video

Updated: Dec 8, 2025

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

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The Nissen Sleeve Gastrectomy: Technical Considerations.

David Nocca¹, Marius Nedelcu², Marcelo Loureiro^1,3

¹CHU de Montpellier, University of Montpellier, Montpellier, France.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A

|September 21, 2020

Summary

A new Nissen fundoplication combined with laparoscopic sleeve gastrectomy (LSG), called N-sleeve, offers similar weight loss and comorbidity improvements as standard LSG. This modified bariatric procedure may also reduce reflux and leaks.

Keywords:

bariatric surgery fundoplication gastrectomy gastroesophageal reflux morbid obesity

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Area of Science:

Bariatric Surgery
Gastrointestinal Surgery
Minimally Invasive Procedures

Background:

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery globally.
Gastroesophageal reflux disease (GERD) and leaks are potential complications of LSG.
A modified technique, N-sleeve, is proposed to address these challenges.

Purpose of the Study:

To describe the technical details of the N-sleeve procedure, a modification of LSG involving Nissen fundoplication.
To present the initial outcomes and technical considerations of this novel bariatric approach.

Main Methods:

The N-sleeve technique involves hiatal hernia repair, creation of a 3cm Nissen valve, and standard LSG stapling.
Key technical tips include avoiding thermal injury, gentle fundus handling, precise wrap creation (4cm from His angle), and intraoperative testing of food pathway.
The procedure is performed laparoscopically.

Main Results:

The N-sleeve technique is technically more demanding than standard LSG.
Initial experience suggests comparable weight loss and comorbidity resolution to standard LSG.
The N-sleeve procedure appears to have a lower incidence of leaks and GERD.

Conclusions:

N-sleeve is a novel bariatric procedure combining LSG with Nissen fundoplication.
While technically challenging, it shows promising results in reducing GERD and leaks.
Further studies are needed to confirm long-term efficacy and safety compared to standard LSG.