腹腔镜袖状胃切除术联合 Rossetti 胃底折叠术（R-Sleeve）治疗病态肥胖和胃食管反流。

Laparoscopic sleeve gastrectomy combined with Rossetti fundoplication (R-Sleeve) for treatment of morbid obesity and gastroesophageal reflux.

机构信息

Policlinico San Marco, General and Oncologic Surgery Department, Zingonia (BG), Italy.

出版信息

Surg Obes Relat Dis. 2017 Dec;13(12):1945-1950. doi: 10.1016/j.soard.2017.08.017. Epub 2017 Aug 26.

DOI:10.1016/j.soard.2017.08.017

PMID:28964697

Abstract

BACKGROUND

Gastroesophageal reflux (GERD) can be considered an obesity-related disease. Roux-en-Y gastric bypass is considered the gold standard for its therapeutic effects on acid reflux.

OBJECTIVES

The aim of this retrospective study is to assess the effectiveness of combined laparoscopic sleeve gastrectomy and Rossetti antireflux fundoplication for the treatment of morbidly obese patients with GERD.

SETTING

A private academic hospital in Italy.

METHODS

Forty obese patients with GERD underwent laparoscopic sleeve gastrectomy-Rossetti laparoscopic fundoplication from January 1 to October 31, 2015. A specific informed consent was obtained. Minimum follow-up was 12 months. No cases were lost to follow-up.

RESULTS

Mean body mass index was 44.4 ± 4.7 kg/m; all patients had GERD. Mean operative time was 38 ± 6 minutes. The mortality rate was 0%. No intraoperative or medium- or long-term complications were reported. Excess weight loss percent at 1, 3, 6, 12 months was 25.6 ± 6.1, 41.9 ± 12.5, 56.7 ± 13.0, 61.7 ± 13.6, respectively. Excess body mass index loss percent at 1, 3, 6, 12 months was 29.3 ± 3.4, 47.2 ± 5.2, 64.0 ± 8.6, 73.3 ± 9.9, respectively. At the 12-month follow-up visit, 95% of the patients reported a good sense of repletion without episodes of vomiting, nausea, or dysphagia.

CONCLUSIONS

Rossetti laparoscopic fundoplication is well tolerated, feasible, and safe in obese patients with GERD, with good postoperative weight results. Following this evidence, 2 monocentric prospective and randomized studies will start to analyze and confirm the reported data.

摘要

背景

胃食管反流（GERD）可被视为一种肥胖相关疾病。Roux-en-Y 胃旁路手术被认为是治疗胃酸反流的金标准。

目的

本回顾性研究旨在评估腹腔镜袖状胃切除术联合 Rossetti 抗反流胃底折叠术治疗肥胖合并 GERD 的疗效。

地点

意大利一家私立学术医院。

方法

2015 年 1 月 1 日至 10 月 31 日，40 例肥胖合并 GERD 的患者接受了腹腔镜袖状胃切除术- Rossetti 腹腔镜胃底折叠术。患者均签署了特定的知情同意书，随访时间至少为 12 个月，无失访病例。

结果

平均体重指数为 44.4 ± 4.7 kg/m2；所有患者均患有 GERD。平均手术时间为 38 ± 6 分钟。无死亡率。无术中或中、长期并发症发生。术后 1、3、6、12 个月的体重减轻率分别为 25.6 ± 6.1%、41.9 ± 12.5%、56.7 ± 13.0%、61.7 ± 13.6%。术后 1、3、6、12 个月的体重指数减轻率分别为 29.3 ± 3.4%、47.2 ± 5.2%、64.0 ± 8.6%、73.3 ± 9.9%。在术后 12 个月的随访中，95%的患者报告饱腹感良好，无呕吐、恶心或吞咽困难。