Franklin Ashanti L, Koeck Emily S, Hamrick Miller C, Qureshi Faisal G, Nadler Evan P
Division of Pediatric Surgery, Children's National Medical Center , Washington, DC.
Surg Infect (Larchmt). 2015 Aug;16(4):401-4. doi: 10.1089/sur.2014.153. Epub 2015 Jun 15.
In adults undergoing gastric bypass surgery, it is routine practice to perform pre-operative testing for Helicobacter pylori infection. Evidence suggests that infection impairs anastomotic healing and contributes to complications. There currently are no data for adolescents undergoing bariatric procedures. Despite few patients with pre-operative symptoms, we noted occasional patients with H. pylori detected after sleeve gastrectomy. We reviewed our experience with our adolescent sleeve gastrectomy cohort to determine the prevalence of H. pylori infection, its predictive factors, and association with outcomes. We hypothesized that H. pylori infection would be associated with pre-operative symptoms, but not surgical outcomes.
All patients undergoing sleeve gastrectomy at our hospital were included. We conducted a chart review to determine pre- or post-operative symptoms of gastroesophageal reflux disease GERD or gastritis, operative complications, and long-term anti-reflux therapy after surgery. Pathology reports were reviewed for evidence of gastritis and H. pylori infection.
78 adolescents had laparoscopic sleeve gastrectomy from January 2010 through July 2014. The prevalence of chronic gastritis was 44.9% (35/78) and 11.4% of those patients had H. pylori (4/35). Only one patient with H. pylori had pre-operative symptoms, and only 25.7% (9/35) of patients with pathology-proven gastritis had symptoms. One staple line leak occurred but this patient did not have H. pylori or gastritis. Mean patient follow-up was 10 (3-26) mos.
There is a moderate prevalence of gastritis among adolescents undergoing sleeve gastrectomy, but only a small number of these patients had H. pylori infection. Neither the presence of chronic gastritis nor H. pylori infection correlated with symptoms or outcomes. Thus, in the absence of predictive symptomology or adverse outcome in those who are infected, we advocate for continued routine pathologic evaluation without the required need for pre-operative determination unless or until H. pylori infection is associated with adverse surgical outcomes.
在接受胃旁路手术的成年人中，术前检测幽门螺杆菌感染是常规操作。有证据表明，感染会损害吻合口愈合并导致并发症。目前尚无青少年接受减肥手术的数据。尽管术前有症状的患者很少，但我们注意到在袖状胃切除术后偶尔会发现幽门螺杆菌感染的患者。我们回顾了青少年袖状胃切除术队列的经验，以确定幽门螺杆菌感染的患病率、预测因素及其与手术结果的关联。我们假设幽门螺杆菌感染与术前症状有关，但与手术结果无关。
纳入我院所有接受袖状胃切除术的患者。我们进行了病历审查，以确定胃食管反流病（GERD）或胃炎的术前或术后症状、手术并发症以及术后长期抗反流治疗情况。审查病理报告以寻找胃炎和幽门螺杆菌感染的证据。
2010年1月至2014年7月，78名青少年接受了腹腔镜袖状胃切除术。慢性胃炎的患病率为44.9%（35/78），其中11.4%的患者感染了幽门螺杆菌（4/35）。只有1名幽门螺杆菌感染患者有术前症状，病理证实为胃炎的患者中只有25.7%（9/35）有症状。发生了1例吻合口漏，但该患者没有幽门螺杆菌感染或胃炎。患者平均随访时间为10（3 - 26）个月。
接受袖状胃切除术的青少年中胃炎患病率中等，但只有少数患者感染了幽门螺杆菌。慢性胃炎的存在和幽门螺杆菌感染均与症状或手术结果无关。因此，在没有预测症状或感染患者出现不良结果的情况下，我们主张继续进行常规病理评估，无需术前确定，除非或直到幽门螺杆菌感染与不良手术结果相关。
