Luketina Ruzica-Rosalia, Koch Oliver Owen, Köhler Gernot, Antoniou Stavros A, Emmanuel Klaus, Pointner Rudolph
Department of General and Visceral Surgery, Sisters of Charity Hospital, Linz, Austria,
Surg Endosc. 2015 Jun;29(6):1327-33. doi: 10.1007/s00464-014-3842-x. Epub 2014 Oct 8.
Obesity has been reported to adversely affect the outcome of laparoscopic antireflux surgery (LARS). This study examined pre- and postoperative clinical and objective outcomes and quality of life in obese and normal-weight patients following LARS at a specialized centre.
Prospective data from patients subjected to LARS (Nissen or Toupet fundoplication) for symptomatic gastroesophageal reflux disease in the General Public Hospital of Zell am See were analyzed. Patients were divided in two groups: normal weight [body mass index (BMI) 20-25 kg/m(2)] and obese (BMI ≥ 30 kg/m(2)). Gastrointestinal quality of life index (GIQLI), symptom grading, esophageal manometry and multichannel intraluminal impedance monitoring data were documented and compared preoperatively and at 1 year postoperatively.
The study cohort included forty normal-weight and forty obese patients. Mean follow-up was 14.7 ± 2.4 months. The mean GIQLI improved significantly after surgery in both groups (p < 0.001, for both). Clinical outcomes improved following surgery regardless of BMI. There were significant improvements of typical and atypical reflux symptoms in normal weight and obese (p = 0.007; p = 0.006, respectively), but no difference in gas bloat and bowel dysfunction symptoms could be found. No intra- or perioperative complications occurred. A total of six patients had to be reoperated (7.5 %), two (5 %) in the obese group and four (10 %) in the normal-weight group, because of recurrent hiatal hernia and slipping of the wrap or persistent dysphagia due to closure of the wrap.
Obesity is not associated with a poorer clinical and objective outcome after LARS. Increased BMI seems not to be a risk factor for recurrent symptomatology and reoperation.
据报道，肥胖会对腹腔镜抗反流手术（LARS）的结果产生不利影响。本研究在一个专业中心检查了肥胖和正常体重患者接受LARS前后的临床和客观结果以及生活质量。
分析了采尔湖畔总医院因症状性胃食管反流病接受LARS（nissen或Toupet胃底折叠术）患者的前瞻性数据。患者分为两组：正常体重[体重指数（BMI）20 - 25kg/m²]和肥胖（BMI≥30kg/m²）。记录并比较术前及术后1年的胃肠道生活质量指数（GIQLI）、症状分级、食管测压和多通道腔内阻抗监测数据。
研究队列包括40名正常体重患者和40名肥胖患者。平均随访时间为14.7±2.4个月。两组术后平均GIQLI均显著改善（两组均p<0.001）。无论BMI如何，手术后临床结果均有改善。正常体重和肥胖患者的典型和非典型反流症状均有显著改善（分别为p = 0.007；p = 0.006），但在气体膨胀和肠道功能障碍症状方面未发现差异。未发生术中或围手术期并发症。共有6名患者需要再次手术（7.5%），肥胖组2名（5%），正常体重组4名（10%），原因是复发性食管裂孔疝、胃底折叠术滑脱或胃底折叠术闭合导致持续性吞咽困难。
肥胖与LARS术后较差的临床和客观结果无关。BMI增加似乎不是复发症状和再次手术的危险因素。
