Lyon A, Gibson S C, De-loyde K, Martin D
Surgical Outcomes Research Centre, University of Sydney, Royal Prince Alfred, Hospital, Camperdown, Sydney, Australia.
Crosshouse Hospital, Crosshouse, Ayrshire, United Kingdom; Concord Repatriation General Hospital, Concord, Sydney, Australia.
Surg Obes Relat Dis. 2015 May-Jun;11(3):530-7. doi: 10.1016/j.soard.2014.08.010. Epub 2014 Aug 23.
Sleeve gastrectomy (SG) has become a definitive treatment for morbid obesity. There is conflicting evidence on the effects of SG on gastroesophageal reflux disease (GERD).
The objective of this study was to assess whether taking an aggressive approach to managing hiatal weakness in patients undergoing SG results in an alteration in GERD symptoms.
Tertiary public hospital and private hospital, Sydney, Australia.
Patients undergoing laparoscopic extended (beginning within 2 cm from pylorus) SG were included. If evidence of weakness was present, an anterior hiatal dissection and tight suture repair was performed. If a hiatus hernia was present, formal repair was undertaken. Patients were questioned and scored on preoperative and postoperative reflux symptom frequency and severity, proton pump inhibitor (PPI) usage, current weight, and satisfaction.
A continuous cohort of 262 patients experienced a significant reduction in heartburn frequency (P = .035) and severity (P = .017). Moderate/severe preoperative reflux (Visick score 3 and 4) often improved whether there was a defect requiring repair or not (no repair P = .02, hiatal suture P = .001, hiatus hernia repair P<.001). The severity of symptoms also improved (no repair P = 0.005, hiatal suture P<.001, hiatus hernia repair P< .001).
Moderate or severe preexisting gastroesophageal reflux improved for most of our obese patients undergoing an extended SG when hiatal defects were routinely repaired. Moderate to severe preoperative reflux also improved in the average obese patient when there was no hiatal defect to repair.
袖状胃切除术（SG）已成为治疗病态肥胖的一种确定性疗法。关于SG对胃食管反流病（GERD）的影响，证据存在冲突。
本研究的目的是评估对接受SG的患者采取积极方法处理食管裂孔薄弱是否会导致GERD症状改变。
澳大利亚悉尼的三级公立医院和私立医院。
纳入接受腹腔镜扩大袖状胃切除术（从幽门起2 cm内开始）的患者。如果存在薄弱证据，则进行食管裂孔前壁解剖和紧密缝合修复。如果存在食管裂孔疝，则进行正规修复。对患者术前和术后的反流症状频率和严重程度、质子泵抑制剂（PPI）使用情况、当前体重和满意度进行询问并评分。
连续纳入的262例患者烧心频率（P = .035）和严重程度（P = .017）显著降低。术前中度/重度反流（Visick评分3和4）通常会改善，无论是否存在需要修复的缺损（未修复P = .02，食管裂孔缝合P = .001，食管裂孔疝修复P <.001）。症状严重程度也有所改善（未修复P = 0.005，食管裂孔缝合P <.001，食管裂孔疝修复P <.001）。
对于大多数接受扩大袖状胃切除术的肥胖患者，当常规修复食管裂孔缺损时，术前中度或重度胃食管反流得到改善。在没有食管裂孔缺损需要修复的情况下，普通肥胖患者术前中度至重度反流也有所改善。
