Arasaki Carlos Haruo, Del Grande José Carlos, Yanagita Edison Takehiko, Alves Ana Karina Soares, Oliveira Daniel Riccioppo C F
Department of Surgery, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.
Obes Surg. 2005 Nov-Dec;15(10):1408-17. doi: 10.1381/096089205774859209.
Frequent regurgitation is a common complication following Roux-en-Y gastric bypass (RYGBP). This study investigated the risk of becoming a chronic regurgitator, by considering silicone ring size and lower esophageal sphincter (LES) function, and their relationship with weight loss.
80 morbidly obese patients were randomly selected to undergo surgery using ring length of 62 mm (40 patients, group A) or 77 mm (40 patients, group B), with 6 months' postoperative follow-up. Preoperative esophageal manometry parameters were correlated with occurrence of chronic postoperative regurgitation. Patients were considered to present chronic regurgitation when this occurred on >10 days/month.
The groups were homogeneous regarding age, gender, race, weight, BMI (47.8+/-6.1 vs 50.2+/-6.4 kg/m2) and obesity-related diseases. There were 15% more chronic regurgitators in group A than in group B. Chronic regurgitators in group A lost more weight than chronic regurgitators in group B (P=0.026) or non-chronic regurgitators in group A (P=0.016). A greater proportion of chronic regurgitators had LES hypotonia (mean respiratory pressure <14 mmHg) than did non-chronic regurgitators (P=0.008). Logistic regression demonstrated that the chance of being a chronic regurgitator in group A was 4.5 times greater than in group B (P=0.046), and that the chance of a chronic regurgitator having LES hypotonia was seven times greater than of having normal LES pressure (P=0.006).
Silicone ring size and LES hypotonia are independent prognostic factors for chronic regurgitation following RYGBP. Ring size and chronic regurgitation contribute significantly towards weight loss during the first 6 postoperative months.
频繁反流是Roux-en-Y胃旁路术（RYGBP）后常见的并发症。本研究通过考虑硅胶环尺寸和食管下括约肌（LES）功能及其与体重减轻的关系，调查了成为慢性反流者的风险。
随机选择80例病态肥胖患者，使用62mm环长（40例患者，A组）或77mm环长（40例患者，B组）进行手术，并进行6个月的术后随访。术前食管测压参数与术后慢性反流的发生相关。当每月反流超过10天时，患者被认为出现慢性反流。
两组在年龄、性别、种族、体重、BMI（47.8±6.1 vs 50.2±6.4kg/m2）和肥胖相关疾病方面具有同质性。A组慢性反流者比B组多15%。A组慢性反流者比B组慢性反流者（P=0.026）或A组非慢性反流者（P=0.016）体重减轻更多。与非慢性反流者相比，慢性反流者中LES张力减退（平均呼吸压力<14mmHg）的比例更高（P=0.008）。逻辑回归显示，A组成为慢性反流者的几率比B组高4.5倍（P=0.046），慢性反流者出现LES张力减退的几率比LES压力正常者高7倍（P=0.006）。
硅胶环尺寸和LES张力减退是RYGBP术后慢性反流的独立预后因素。环尺寸和慢性反流在术后前6个月对体重减轻有显著贡献。
