Sharma Aditya, Aggarwal Sandeep, Ahuja Vineet, Bal Chandrashekhar
Departments of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Departments of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
Surg Obes Relat Dis. 2014 Jul-Aug;10(4):600-5. doi: 10.1016/j.soard.2014.01.017. Epub 2014 Jan 28.
The effect of laparoscopic sleeve gastrectomy (SG) on gastroesophageal reflux disease (GERD) has been a controversial issue. There have been limited studies on this aspect and most of the published studies are retrospective. Therefore, a prospective study was designed to objectively assess the problem. The objective of this study was to assess the impact of SG on symptoms of gastroesophageal reflux using questionnaire, endoscopy, and radionuclide scintigraphy.
Thirty-two patients undergoing laparoscopic sleeve gastrectomy were assessed for gastroesophageal reflux using Carlsson Dent Questionnaire and GERD questionnaire before and after surgery at three monthly intervals. They were also subjected to upper GI endoscopy (UGIE) and radionuclide scintigraphy both pre- and postoperatively.
Mean preoperative weight and body mass index were 126.5 kg and 47.8 kg/m2, respectively. Mean percent excess weight loss at 12 months was 64.3 ± 18.4. Both the Carlsson Dent Score (CDS) and Severity Score (SS) exhibited a decline from 2.88 to 1.63 (p<0.05) and 2.28 to 1.06 (p<0.05), respectively after 12 months. Radionuclide scintigraphy revealed a significant rise of GERD from 6.25% to 78.1% in the postoperative period (p<0.001). UGIE showed a rise in incidence of esophagitis from 18.8% to 25%; however, there was improvement in all patients except one in terms of reduction of severity of esophagitis.
Presence of GERD may not be considered as a contra-indication for sleeve gastrectomy. There is improvement of GERD as assessed by symptom questionnaires, as well as improvement in grade of esophagitis. The new onset GERD detected on scintigraphy may not be pathologic as there is a decrease in total acid production postsurgery; however, it still remains an important issue and needs long-term follow-up.
腹腔镜袖状胃切除术（SG）对胃食管反流病（GERD）的影响一直是个有争议的问题。这方面的研究有限，且大多数已发表的研究都是回顾性的。因此，设计了一项前瞻性研究来客观评估这个问题。本研究的目的是使用问卷调查、内镜检查和放射性核素闪烁扫描来评估SG对胃食管反流症状的影响。
对32例行腹腔镜袖状胃切除术的患者在术前及术后每隔三个月使用卡尔森·登特问卷和GERD问卷评估胃食管反流情况。他们在术前和术后还接受了上消化道内镜检查（UGIE）和放射性核素闪烁扫描。
术前平均体重和体重指数分别为126.5千克和47.8千克/平方米。12个月时平均超重减轻百分比为64.3±18.4。12个月后，卡尔森·登特评分（CDS）和严重程度评分（SS）分别从2.88降至1.63（p<0.05）和从2.28降至1.06（p<0.05）。放射性核素闪烁扫描显示术后GERD从6.25%显著升至78.1%（p<0.001）。UGIE显示食管炎发生率从18.8%升至25%；然而，除1例患者外，所有患者的食管炎严重程度均有所减轻。
胃食管反流病的存在可能不应被视为袖状胃切除术的禁忌证。通过症状问卷评估，胃食管反流病有所改善，食管炎等级也有所改善。闪烁扫描检测到的新发胃食管反流病可能并非病理性的，因为术后总酸分泌减少；然而，这仍然是一个重要问题，需要长期随访。
