Moon Rena C, Teixeira Andre F, Jawad Muhammad A
Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, FL.
Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, FL.
Surg Obes Relat Dis. 2017 Apr;13(4):547-552. doi: 10.1016/j.soard.2016.10.008. Epub 2016 Oct 17.
Laparoscopic sleeve gastrectomy has become a popular bariatric surgery in recent years. However, it has been linked to worsening or newly developed gastroesophageal reflux disease (GERD) in the postoperative period.
The purpose of this study is to determine the safety and effectiveness of anterior fundoplication sleeve gastrectomy in patients with reflux.
Academic hospital, United States.
We prospectively collected data on 31 sleeve gastrectomy patients who concurrently underwent anterior fundoplication between July 2014 and March 2016. Patients were selected when they reported severe reflux before the procedure. Each patient was interviewed using the GERD score questionnaire (scaled severity and frequency of heartburn, regurgitation, epigastric pain, epigastric fullness, dysphagia, and cough) before and 4 months after the procedure.
Our patients comprised 27 females and 4 males with a mean age of 49.9±9.6 years (range, 29-63 yr). They had a mean preoperative body mass index of 42.8±5.6 kg/m (range, 33.3-58.4 kg/m), and 67.7% (n = 21) of these patients underwent hiatal hernia repair as well. Preoperatively, patients had a mean heartburn score of 7.4±3.6 (range, 1-12), regurgitation score of 5.4±4.1 (range, 0-12), epigastric pain score of 2.1±3.2 (range, 0-12), epigastric fullness score of 2.7±3.9 (range, 0-12), dysphagia score of 1.3±2.2 (range, 0-9), and cough score of .9±1.8 (range, 0-6). Mean preoperative GERD score was 18.9±9.8 (range, 6-36) in these patients. Patients were interviewed with the same questionnaire approximately 4 months postoperative. Patients had a mean heartburn score of 1.5±3.2 (range, 0-12), regurgitation score of .9±1.7 (range, 0-8), epigastric pain score of .4±1.1 (range, 0-4), epigastric fullness score of 1.1±2.4 (range, 0-8), dysphagia score of .3±1.1 (range, 0-6), and cough score of 0. Mean postoperative GERD score dropped down to 4.1±5.8 (range, 0-28), and the difference was statistically significant (P<.01). One patient was readmitted 28 days later for a staple line leakage, and was treated conservatively. No patient required a reoperation due to the procedure within 30 days.
Anterior fundoplication sleeve gastrectomy may be a safe and effective alternative in obese patients with severe reflux who want to undergo sleeve gastrectomy.
近年来，腹腔镜袖状胃切除术已成为一种流行的减肥手术。然而，它与术后胃食管反流病（GERD）的恶化或新发有关。
本研究的目的是确定前壁胃底折叠术式袖状胃切除术对反流患者的安全性和有效性。
美国学术医院。
我们前瞻性收集了2014年7月至2016年3月期间同时接受前壁胃底折叠术的31例袖状胃切除术患者的数据。入选患者为术前报告有严重反流的患者。在手术前和术后4个月，使用GERD评分问卷（按烧心、反流、上腹部疼痛、上腹部饱胀、吞咽困难和咳嗽的严重程度和频率进行评分）对每位患者进行访谈。
我们的患者包括27名女性和4名男性，平均年龄为49.9±9.6岁（范围29 - 63岁）。他们术前平均体重指数为42.8±5.6 kg/m²（范围33.3 - 58.4 kg/m²），其中67.7%（n = 21）的患者还接受了食管裂孔疝修补术。术前，患者烧心平均评分为7.4±3.6（范围1 - 12），反流评分为5.4±4.1（范围0 - 12），上腹部疼痛评分为2.1±3.2（范围0 - 12），上腹部饱胀评分为2.7±3.9（范围0 - 12），吞咽困难评分为1.3±2.2（范围0 - 9），咳嗽评分为0.9±1.8（范围0 - 6）。这些患者术前GERD平均评分为18.9±9.8（范围6 - 36）。术后约4个月用相同问卷对患者进行访谈。患者烧心平均评分为1.5±3.2（范围0 - 12），反流评分为0.9±1.7（范围0 - 8），上腹部疼痛评分为0.4±1.1（范围0 - 4），上腹部饱胀评分为1.1±2.4（范围0 - 8），吞咽困难评分为0.3±1.1（范围0 - 6），咳嗽评分为0。术后GERD平均评分降至4.1±5.8（范围0 - 28），差异有统计学意义（P <.01）。1例患者术后28天因吻合口漏再次入院，经保守治疗。30天内无患者因手术需要再次手术。
对于想要接受袖状胃切除术的重度反流肥胖患者，前壁胃底折叠术式袖状胃切除术可能是一种安全有效的选择。
