Samakar Kamran, McKenzie Travis J, Tavakkoli Ali, Vernon Ashley H, Robinson Malcolm K, Shikora Scott A
Department of General Surgery, Loma Linda University Medical Center, Coleman Pavilion 21111, 11175 Campus Street, Loma Linda, CA, 92350, USA.
Department of General Surgery, Mayo Clinic, Rochester, MN, USA.
Obes Surg. 2016 Jan;26(1):61-6. doi: 10.1007/s11695-015-1737-0.
The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG.
A single institution, multi-surgeon, prospectively maintained database was examined to identify patients who underwent LSG and concomitant HHR from December 2010 to October 2013. Patient characteristics, operative details, and postoperative outcomes were analyzed. Standardized patient questionnaires administered both pre- and postoperatively were utilized. Primary endpoints included subjective reflux symptoms and the need for antisecretory therapy. Weight loss was considered a secondary endpoint.
Fifty-eight patients were identified meeting inclusion criteria (LSG + HHR), with a mean follow-up of 97.5 weeks (range 44-172 weeks). The mean age of the cohort was 49.5 ± 11.2 years, with 74.1 % being female. Mean preoperative BMI was 44.2 ± 6.6 kg/m(2). Preoperative upper gastrointestinal contrast series was performed in all patients and demonstrated a hiatal hernia in 34.5 % of patients and reflux in 15.5 % of patients. Preoperatively, 44.8 % (n = 26) of patients reported subjective symptoms of reflux and/or required daily antisecretory therapy [Corrected]. After LSG + HHR, 34.6 % of symptomatic patients had resolution of their symptoms off therapy while the rest remained symptomatic and required daily antisecretory therapy; 84.4 % of patients that were asymptomatic preoperatively remained asymptomatic after surgery. New onset reflux symptoms requiring daily antisecretory therapy was seen in 15.6 % of patients who were previously asymptomatic. Post surgical weight loss did not correlate with the presence or resolution of reflux symptoms.
Based on our data, LSG with concomitant HHR improved GERD symptoms or the need for daily antisecretory therapy only in a third of symptomatic patients. Furthermore, 15.6 % of asymptomatic patients developed de novo GERD symptoms despite a HHR. In patients with a documented hiatal hernia, HHR does not lead to GERD resolution or prevention after LSG, indicating the need for appropriate patient counseling and further study.
腹腔镜袖状胃切除术（LSG）对胃食管反流病（GERD）的影响存在争议。尽管在进行LSG时同时行食管裂孔疝修补术（HHR）很常见且为许多人所提倡，但关于这些患者GERD症状结局的数据却很少。本研究的目的是评估在接受LSG的病态肥胖患者中同时行HHR对GERD症状的影响。
对一个单一机构、多外科医生、前瞻性维护的数据库进行检查，以确定2010年12月至2013年10月期间接受LSG及同时行HHR的患者。分析患者特征、手术细节及术后结局。使用术前和术后均采用的标准化患者问卷。主要终点包括主观反流症状及抗分泌治疗的需求。体重减轻被视为次要终点。
确定58例患者符合纳入标准（LSG + HHR），平均随访97.5周（范围44 - 172周）。该队列的平均年龄为49.5±11.2岁，74.1%为女性。术前平均BMI为44.2±6.6kg/m²。所有患者均进行了术前上消化道造影，34.5%的患者显示有食管裂孔疝，15.5%的患者有反流。术前，44.8%（n = 26）的患者报告有主观反流症状和/或需要每日抗分泌治疗[校正后]。在LSG + HHR后，34.6%有症状的患者在停止治疗后症状缓解，其余患者仍有症状且需要每日抗分泌治疗；术前无症状的患者中84.4%术后仍无症状。15.6%术前无症状的患者出现了需要每日抗分泌治疗的新发反流症状。术后体重减轻与反流症状的存在或缓解无关。
根据我们的数据，LSG同时行HHR仅使三分之一有症状的患者的GERD症状或每日抗分泌治疗的需求得到改善。此外，15.6%无症状的患者尽管进行了HHR仍出现了新发GERD症状。在有记录的食管裂孔疝患者中，HHR在LSG后并不能导致GERD的缓解或预防，这表明需要对患者进行适当咨询并进一步研究。
