Lew J I, Daud A, DiGorgi M F, Olivero-Rivera L, Davis D G, Bessler M
Center for Obesity Surgery, New York-Presbyterian Hospital and Columbia University, College of Physicians and Surgeons, 161 Fort Washington Avenue, 6th Floor, Room 620, New York, New York 10032, USA.
Surg Endosc. 2006 Aug;20(8):1242-7. doi: 10.1007/s00464-005-0589-4. Epub 2006 Jul 20.
Laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity has been reported to provide long-term weight loss with a low risk of operative complications. Nevertheless, esophageal dilation leading to achalasia-like and reflux symptoms is a feared complication of LASGB. This study evaluates the clinical benefit of routine preoperative esophageal manometry in predicting outcome after LASGB in morbidly obese patients.
A review of prospectively collected data on 77 patients who underwent routine esophageal manometry prior to LASGB for morbid obesity from February 2001 to September 2003 was performed. Aberrant motility, abnormal lower esophageal sphincter (LES) pressures, and other nonspecific esophageal motility disorders noted on preoperative esophageal manometry defined patients of the abnormal manometry group. Outcome differences in weight loss, emesis, band complications, and gastroesophageal reflux disease (GERD) resolution or improvement were compared between patients of the abnormal and normal manometry groups after LASGB. Analysis of variance (ANOVA) and chi-square tests were performed to determine the significance of these outcomes.
Of the patients tested, 14 had abnormal esophageal manometry results, whereas 63 had normal manometry results before LASGB. There was no significant difference in percent excess weight loss (%EWL) at 6 and 12 months between the groups after gastric banding. Severe postoperative emesis occurred more frequently in patients with abnormal manometry results than in those with normal manometry results. There were two band-related complications, both of which occurred in patients of the normal manometry group.
Preoperative esophageal manometry does not predict weight loss or GERD outcomes after LASGB in morbidly obese patients. Postoperative emesis was more common in patients with abnormal manometry findings, but such symptoms were manageable and did not lead to poor weight loss or to band removal or increased band-related complications.
据报道,用于治疗病态肥胖的腹腔镜可调节硅胶胃束带术(LASGB)可实现长期体重减轻,且手术并发症风险较低。然而,食管扩张导致类似贲门失弛缓症和反流症状是LASGB令人担忧的并发症。本研究评估了常规术前食管测压对预测病态肥胖患者LASGB术后结局的临床益处。
回顾性分析2001年2月至2003年9月期间77例因病态肥胖接受LASGB术前常规食管测压的患者的前瞻性收集数据。术前食管测压发现的异常动力、食管下括约肌(LES)压力异常及其他非特异性食管动力障碍定义为异常测压组患者。比较LASGB术后异常测压组和正常测压组患者在体重减轻、呕吐、束带并发症及胃食管反流病(GERD)缓解或改善方面的结局差异。采用方差分析(ANOVA)和卡方检验确定这些结局的显著性。
在接受测试的患者中,14例食管测压结果异常,而63例在LASGB术前测压结果正常。胃束带术后6个月和12个月时,两组间超重体重减轻百分比(%EWL)无显著差异。测压结果异常的患者术后严重呕吐发生率高于测压结果正常的患者。有2例与束带相关的并发症,均发生在正常测压组患者中。
术前食管测压不能预测病态肥胖患者LASGB术后的体重减轻或GERD结局。测压结果异常的患者术后呕吐更常见,但此类症状可控制,不会导致体重减轻不佳、束带移除或束带相关并发症增加。