Pagé Maurice-Pierre, Kastenmeier Andrew, Goldblatt Matthew, Frelich Matthew, Bosler Matthew, Wallace James, Gould Jon
Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA.
Surg Endosc. 2014 May;28(5):1500-4. doi: 10.1007/s00464-013-3343-3. Epub 2013 Dec 6.
Obesity is a recognized risk factor for gastroesophageal reflux disease (GERD). Traditional antireflux surgery (fundoplication) may not be appropriate in the morbidly obese, especially when other effective alternatives exist (bariatric surgery).
A 13-item survey was designed to elicit professional opinions regarding the treatment of medically refractory GERD in obese patients. Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) were randomly selected and emailed a link to an online survey.
A total of 550 surgeons were contacted via email, and 92 (17 %) completed the survey. Of the respondents, 88 % perform laparoscopic antireflux surgery, 63 % perform bariatric surgery, and 59 % perform both. Overall, 77 % completed a minimally invasive surgery fellowship. In response to the question "Would you perform a laparoscopic fundoplication in a patient with medically refractory GERD and a BMI of 'X'?" surgeons were less likely to offer fundoplication at a higher body mass index (BMI). The majority of respondents felt that laparoscopic Roux-en-Y gastric bypass was the best option (91 %), followed by laparoscopic sleeve gastrectomy (6 %). Many had a morbidly obese patient with a primary surgical indication of GERD denied a bariatric procedure by their insurance company (57 %), and 35 % of those surgeons chose to do nothing rather than subject the patient to a fundoplication. Respondents uniformly felt that bariatric surgery should be recognized as a standard surgical option for treating GERD in the obese (96 %).
When surgical treatment of GERD is indicated in an obese patient, bariatric surgery is the optimal approach, in the opinion of surgeons responding to our survey. Unfortunately, third-party payers often decline to provide benefits for a bariatric procedure for this indication. Additional data is necessary to confirm our belief that the opinions elicited through this survey are consistent with the standard of care as defined by the medical community.
肥胖是公认的胃食管反流病（GERD）的危险因素。传统的抗反流手术（胃底折叠术）可能不适用于病态肥胖患者，尤其是当存在其他有效替代方案（减肥手术）时。
设计了一项包含13个项目的调查问卷，以征求关于肥胖患者药物难治性GERD治疗的专业意见。随机选择美国胃肠和内镜外科医师协会（SAGES）的成员，并通过电子邮件向他们发送在线调查问卷的链接。
通过电子邮件联系了总共550名外科医生，其中92名（17%）完成了调查。在受访者中，88%进行腹腔镜抗反流手术，63%进行减肥手术，59%两者都做。总体而言，77%完成了微创外科 fellowship。对于“你会为一名药物难治性GERD且BMI为‘X’的患者进行腹腔镜胃底折叠术吗？”这个问题，外科医生在较高体重指数（BMI）时提供胃底折叠术的可能性较小。大多数受访者认为腹腔镜Roux-en-Y胃旁路术是最佳选择（91%），其次是腹腔镜袖状胃切除术（6%）。许多人有肥胖患者因GERD作为主要手术指征被保险公司拒绝进行减肥手术（57%），并且35%的外科医生选择不采取任何措施而不是让患者接受胃底折叠术。受访者一致认为减肥手术应被视为治疗肥胖患者GERD的标准手术选择（96%）。
在参与我们调查的外科医生看来，当肥胖患者需要手术治疗GERD时，减肥手术是最佳方法。不幸的是，第三方支付者通常拒绝为该指征的减肥手术提供福利。需要更多数据来证实我们的观点，即通过本次调查得出的意见与医学界定义的医疗标准一致。
