Surgical-Medical Department for Digestive Diseases, Policlinico Umberto I, University of Rome Sapienza, Rome, Italy.
Surg Obes Relat Dis. 2013 May-Jun;9(3):356-61. doi: 10.1016/j.soard.2012.06.003. Epub 2012 Jun 19.
Gastroesophageal reflux disease (GERD) with or without hiatal hernia (HH) is now recognized as an obesity-related co-morbidity. Roux-en-Y gastric bypass has been proved to be the most effective bariatric procedure for the treatment of morbidly obese patients with GERD and/or HH. In contrast, the indication for laparoscopic sleeve gastrectomy (SG) in these patients is still debated. Our objective was to report our experience with 97 patients who underwent SG and HH repair (HHR). The setting was a university hospital in Italy.
From July 2009 to December 2011, 378 patients underwent a preoperative workup for SG. In 97 patients, SG was performed with HHR. The clinical outcome was evaluated considering GERD symptom resolution or improvement, interruption of antireflux medications, and radiographic evidence of HH recurrence.
Before surgery, symptomatic GERD was present in 60 patients (15.8%), and HH was diagnosed in 42 patients (11.1%). In 55 patients (14.5%), HH was diagnosed intraoperatively. The mean follow-up was 18 months. GERD remission occurred in 44 patients (73.3%). In the remaining 16 patients, antireflux medications were diminished, with complete control of symptoms in 5 patients. No HH recurrences developed. "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR.
SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively.
胃食管反流病（GERD）伴或不伴食管裂孔疝（HH）现在被认为是肥胖的一种相关合并症。Roux-en-Y 胃旁路术已被证明是治疗伴有 GERD 和/或 HH 的病态肥胖患者的最有效减肥手术。相比之下，腹腔镜袖状胃切除术（SG）在这些患者中的适应证仍存在争议。我们的目的是报告我们对 97 例接受 SG 和 HH 修复（HHR）的患者的经验。该研究在意大利的一家大学医院进行。
从 2009 年 7 月到 2011 年 12 月，378 例患者接受了 SG 的术前检查。在 97 例患者中，进行了 SG 和 HHR。通过 GERD 症状缓解或改善、抗反流药物中断以及 HH 复发的影像学证据来评估临床结果。
术前，60 例（15.8%）存在有症状的 GERD，42 例（11.1%）诊断为 HH。55 例（14.5%）患者在术中诊断为 HH。平均随访时间为 18 个月。44 例（73.3%）患者 GERD 缓解。在其余 16 例患者中，抗反流药物减少，5 例患者症状完全得到控制。未发生 HH 复发。与单独接受 SG 的患者相比，接受 SG+HHR 的患者中，新发 GERD 症状的发生率为 22.9%，而单独接受 SG 的患者中为 0%。
SG+HHR 是可行且安全的，可为有反流症状的肥胖患者提供 GERD 的良好管理。术前内镜和/或上消化道造影检查可能低估小的食管裂孔缺损。因此，建议术中始终仔细检查膈脚。
