da Silva Leonardo Emilio, Alves Maxley M, El-Ajouz Tanous Kalil, Ribeiro Paula C P, Cruz Ruy J
Instituto de Cirurgia Metabólica, Obesidade e Aparelho Digestivo (ICAD), Rua 9 numero 130 ap 1802, Goiânia, GO, 74110-100, Brazil,
Obes Surg. 2015 Jul;25(7):1217-22. doi: 10.1007/s11695-014-1523-4.
Some studies have recently suggested that laparoscopic sleeve gastrectomy may exacerbate gastroesophageal reflux disease (GERD) symptoms or even increase the risk of "de novo" post-operative GERD. We herein describe and evaluate the initial response of an alternative technique of sleeve gastroplasty combined with Nissen fundoplication for morbidly obese patients who present significant GERD.
From January 2008 to December 2013, 122 morbidly obese patients underwent laparoscopic Sleeve-Collis-Nissen gastroplasty (LSCNG).
The great majority of the patients were female (97.5 %), with a mean age of 42.4 years old (from 18 to 72). Hiatal hernia and use of proton pump inhibitors (PPIs) were presented in 54.9 and 92 %, respectively. The mean operative time was 91 ± 6 min. The mean hospitalization stay was 2 ± 0.3 days. Major complications including stenosis requiring endoscopic dilation and GI bleeding were observed in five patients (4.1 %). No leaks were observed. One-year follow-up showed a significant decrease in the prevalence of esophagitis (100 vs 13.6 %) and the use of PPIs (92 vs 13.6 %). The percentages of excess weight loss 1 and 3 years after the surgery were 64.4 ± 7.2 and 60.4 ± 8.1 %, respectively.
LSCNG is a novel, technically feasible surgery with a low incidence of procedure-related complications. However, further prospective studies are required to assess the real impact of this procedure on the improvement of GERD symptoms.
最近一些研究表明，腹腔镜袖状胃切除术可能会加重胃食管反流病（GERD）症状，甚至增加术后“新发”GERD的风险。在此，我们描述并评估一种替代技术——袖状胃成形术联合nissen胃底折叠术，用于治疗伴有严重GERD的病态肥胖患者的初始反应。
2008年1月至2013年12月，122例病态肥胖患者接受了腹腔镜袖状 - 科利斯 - nissen胃成形术（LSCNG）。
绝大多数患者为女性（97.5%），平均年龄42.4岁（18至72岁）。分别有54.9%和92%的患者存在食管裂孔疝和使用质子泵抑制剂（PPI）。平均手术时间为91±6分钟。平均住院时间为2±0.3天。5例患者（4.1%）出现了包括需要内镜扩张的狭窄和胃肠道出血在内的主要并发症。未观察到渗漏。1年随访显示食管炎患病率（100%对13.6%）和PPI使用情况（92%对13.6%）有显著下降。术后1年和3年的超重减轻百分比分别为64.4±7.2%和60.4±8.1%。
LSCNG是一种新颖、技术上可行的手术，与手术相关的并发症发生率低。然而，需要进一步的前瞻性研究来评估该手术对改善GERD症状的实际影响。
