Lasnibat Juan Pablo, Braghetto Italo, Gutierrez Luis, Sanchez Felipe
Department of Surgery, Faculty of Medicine, University Hospital Dr José J. Aguirre, Santiago, Chile.
Arq Bras Cir Dig. 2017 Jul-Sep;30(3):216-221. doi: 10.1590/0102-6720201700030012.
Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia.
To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone.
Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made.
Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated with symptomatic reflux, and one underwent re-intervention for reflux.
Good results are observed in the short-term follow up in both reflux resolution and weight loss. Nevertheless, results at long term are discouraging, with 53.3% of the patients requiring revision surgery during follow-up.
近年来，智利的减肥手术呈指数级增长，尤其是袖状胃切除术。目前，对于患有胃食管反流病的患者是否采用该手术存在争议。针对这些患者的治疗，人们考虑了不同的选择，但到目前为止，腹腔镜Roux-en-Y胃旁路手术似乎是最佳选择。对于有反流或小食管裂孔疝的患者，也有人建议行袖状胃切除术加同期胃底折叠术或食管裂孔疝修补术。
介绍一组接受该手术的肥胖胃食管反流患者，旨在评估腹腔镜袖状胃切除术（LSG）和抗反流手术的益处，重点关注术后反流情况和体重指数（BMI），并将该组患者的结果与之前一组仅接受袖状胃切除术的无反流肥胖患者进行比较。
对2003年至2012年间接受该手术的15例患者进行回顾性病例系列研究。分析临床记录，并记录24小时pH监测、食管测压结果及临床结局。将结果与之前一组接受LSG的患者进行比较。未进行统计学分析。
A组由15例行LSG加胃底折叠术的患者组成。93%（n = 14）为女性。平均年龄为46.2岁。术前平均体重指数（BMI）为33.9。所有患者术前pH监测和测压均异常。发生1例轻微并发症，为血清肿。无围手术期死亡。B组由23例行LSG的肥胖患者组成。这些患者术后出现新发反流、下食管括约肌压力降低和食管炎。A组患者术后3个月食管pH监测和测压有所改善。在长期随访中，6例患者接受了翻修手术，4例因体重反弹，1例体重反弹并伴有症状性反流，1例因反流接受再次干预。
在短期随访中，反流缓解和体重减轻方面均取得了良好效果。然而，长期结果令人沮丧，53.3%的患者在随访期间需要接受翻修手术。
