Dakour Aridi Hanaa, Asali Mohammad, Fouani Tarek, Alami Ramzi S, Safadi Bassem Y
Department of Surgery, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut, Beirut, 1107 2020, Lebanon.
Obes Surg. 2017 Nov;27(11):2898-2904. doi: 10.1007/s11695-017-2702-x.
The effectiveness of the concomitant repair of hiatal hernia (HHR) during laparoscopic sleeve gastrectomy (LSG) in reducing gastroesophageal reflux disease (GERD) symptoms is still unclear. The aim of this study is to assess the effect of concomitant HHR on postoperative GERD symptoms in our patient population.
A retrospective review of patients who underwent LSG with or without HHR between 2011and 2014 was performed. Pre- and postoperative GERD symptoms were assessed at different time intervals until a maximum of 2 years after the surgery.
The study included 165 patients; 76 (46%) underwent LSG with concomitant HHR (group A) while the rest underwent only LSG (group B). Baseline GERD complaints were more prevalent in group A (61.8 vs 41.6%, p = 0.04), in which 44 patients (57.9%) had evidence of hiatal hernia on preoperative EGD. In the remaining 32 patients, it was diagnosed intraoperatively. GERD symptoms did not significantly differ between the two groups after years 1 and 2. GERD remission was observed in 21.3% of the 76 patients who underwent concomitant HHR (group A) and in 29.7% of those who did not (group B) while new-onset GERD symptoms were reported in 12 patients (41.4%) in group A and in 24 patients (46.2%) in group B.
Routine HHR at the time of LSG does not show an improvement in GERD symptoms. More prospective studies are needed to clarify the role of the routine dissection, identification, and repair of concomitant hiatal hernia during LSG.
腹腔镜袖状胃切除术（LSG）期间同时修复食管裂孔疝（HHR）在减轻胃食管反流病（GERD）症状方面的有效性仍不明确。本研究的目的是评估在我们的患者群体中同时进行HHR对术后GERD症状的影响。
对2011年至2014年间接受或未接受HHR的LSG患者进行回顾性研究。在不同时间间隔评估术前和术后的GERD症状，直至术后最长2年。
该研究纳入了165例患者；76例（46%）接受了LSG并同时进行HHR（A组），其余患者仅接受了LSG（B组）。A组基线GERD主诉更为普遍（61.8%对41.6%，p = 0.04），其中44例患者（57.9%）术前内镜检查有食管裂孔疝证据。其余32例患者术中确诊。1年和2年后两组之间的GERD症状无显著差异。在接受同时HHR的76例患者（A组）中，21.3%观察到GERD缓解，未接受同时HHR的患者（B组）中这一比例为29.7%，而A组有12例患者（41.4%）报告出现新发GERD症状，B组有24例患者（46.2%）报告出现新发GERD症状。
LSG时常规进行HHR并未显示出GERD症状有所改善。需要更多前瞻性研究来阐明LSG期间常规解剖、识别和修复同时存在的食管裂孔疝的作用。
