Ruscio Sara, Abdelgawad Mohamed, Badiali Danilo, Iorio Olga, Rizzello Mario, Cavallaro Giuseppe, Severi Carola, Silecchia Gianfranco
Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnologies, Bariatric Center of Excellence IFSO EU, "La Sapienza" University of Rome, Via F. Faggiana 1668, 04100, Latina, Italy.
Gastroenterology Surgical Center, Faculty of medicine, Mansoura University, Mansoura, Egypt.
Surg Endosc. 2016 Jun;30(6):2374-81. doi: 10.1007/s00464-015-4487-0. Epub 2015 Oct 1.
Crural closure in addition to laparoscopic sleeve gastrectomy (LSG) represents a valuable option for the synchronous management of morbid obesity and hiatal defects, providing good outcomes in terms of weight loss and gastroesophageal reflux disease (GERD) symptoms control. The aim of this prospective study was to evaluate the safety and effectiveness of the reinforced cruroplasty during LSG compared with a concurrent group of simple cruroplasty.
The study groups included 96 morbidly obese patients who underwent simultaneous LSG and cruroplasty. Group A: 48 patients with hiatal areal defect <4 cm(2) and normal pillars (simple posterior cruroplasty); group B: 48 patients with hiatal areal defect >4 and <8 cm(2) with weakness of the right pillar (on-lay synthetic absorbable mesh-reinforced cruroplasty). Upper GI symptoms were assessed by Roma III standard questionnaire. Endoscopy, imaging, esophageal 24-h pH monitoring and HR manometry were performed in cases of persistent or recurrent symptoms after surgery.
Mortality rate was nil. The conversion rate to open was 1 %. Intra-operative diagnosis of hiatal hernia occured in 41 patients (42.7 %). Mesh-related complications were none. Perioperative complications occurred in four patients (4.1 %). After 19- to 21-month follow-up, GERD symptom remission occurred in 89 % of patients. GERD symptoms were detected postoperatively in eight patients: six in group A (five symptomatic and radiological recurrences and one persistent) and two in group B (one persistent and one de novo GERD) (P < 0.05).
The synthetic absorbable mesh offers an effective option for crural repair during LSG with no clinical recurrences at 19 months. The midterm results of this prospective comparative study evaluating two different technical options for cruroplasty confirm that the simultaneous procedures are safe and cruroplasty is effective in mild-to-moderate GERD control .
除腹腔镜袖状胃切除术（LSG）外，缝合膈肌裂孔是同步治疗病态肥胖症和食管裂孔缺损的一种有效选择，在体重减轻和胃食管反流病（GERD）症状控制方面能取得良好效果。本前瞻性研究的目的是评估在LSG过程中使用强化膈肌成形术与同期单纯膈肌成形术组相比的安全性和有效性。
研究组包括96例接受同期LSG和膈肌成形术的病态肥胖患者。A组：48例食管裂孔面积缺损<4 cm²且膈脚正常的患者（单纯后路膈肌成形术）；B组：48例食管裂孔面积缺损>4 cm²且<8 cm²、右侧膈脚薄弱的患者（补片置入合成可吸收网片强化膈肌成形术）。采用罗马III标准问卷评估上消化道症状。术后出现持续或复发症状的患者进行内镜检查、影像学检查、食管24小时pH监测和高分辨率测压。
死亡率为零。转为开腹手术的比例为1%。术中诊断出食管裂孔疝41例（42.7%）。无补片相关并发症。围手术期并发症发生在4例患者（4.1%）。经过19至21个月的随访，89%的患者GERD症状缓解。术后8例患者检测到GERD症状：A组6例（5例症状性和影像学复发，1例持续存在）；B组2例（1例持续存在，1例新发GERD）（P<0.05）。
合成可吸收网片为LSG过程中的膈肌修复提供了一种有效的选择，在19个月时无临床复发。这项前瞻性对比研究评估两种不同膈肌成形术技术方案的中期结果证实，同期手术是安全的，膈肌成形术在轻至中度GERD控制方面是有效的。
