Weight loss outcomes after Nissen sleeve gastrectomy vs standard sleeve gastrectomy in female patients: a retrospective matched‑cohort study

Abstract

Introduction  Nissen-sleeve gastrectomy (NSG) has been proposed as a modification combining SG with an anti-reflux component. However, its impact on weight-loss outcomes remains controversial. Comparative data between SG and NSG remain limited.

Aim    The aim of the study was to compare weight loss after NSG and SG at a minimum of 12 months following surgery.

Materials and methods        This retrospective matched cohort study included patients who underwent NSG at a high-volume bariatric center between 2023 and 2025. NSG patients were matched in a 1:2 ratio with patients undergoing standard SG using propensity score matching based on age, preoperative body mass index (BMI), and date of surgery. Weight-loss outcomes, including percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL), were assessed at a minimum follow-up of 12 months. Subgroup analyses were performed according to follow-up duration (<20 vs ≥20 months).

Results           25 patients undergoing NSG were matched with 50 SG patients. All patients were female. At a median follow-up of approximately 20 months, SG was associated with significantly higher %TWL and %EWL compared with NSG (32.2% vs 29.3%; P = 0.012 and 87.3% vs 78.5%; P = 0.017, respectively). After stratification by follow-up duration, significant differences were observed only in patients with follow-up <20 months, whereas weight-loss outcomes were comparable between procedures in patients followed for ≥20 months. Operative time was significantly longer for NSG, while length of hospital stay was similar. One Clavien–Dindo III complication occurred in the NSG group.

Conclusions   SG was associated with greater early weight loss compared with NSG. However, these differences diminished with longer follow-up.