Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP, 050652-900, Brazil.
Obes Surg. 2019 Apr;29(4):1439-1441. doi: 10.1007/s11695-019-03752-4.
Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD). The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30. Although still controversial in the literature, there are several studies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The current video shows the technique of a SG with cardioplication associated with transit bipartition (TB) for the treatment of an obese patient with severe GERD.
A 46-year-old male presented with obesity and GERD symptoms for several years. His BMI was 37.8 kg/m with mainly central obesity and several obesity-related comorbidities, including hypertension, dyslipidemia, severe insulin resistance, and obstructive sleep apnea. After a diagnostic evaluation, the patient was submitted to a sleeve gastrectomy with a transit bipartition. He presented satisfactory weight loss, reaching a BMI of 26 and remission of all comorbidities and complete remission of GERD symptoms. The current follow-up period is 2.5 years and the patient did not present any weight regain or return of the GERD symptoms.
We presented a surgical alternative that is effective in both weight loss and remission of GERD. SG + TB is a potent intervention for metabolic syndrome and obesity. Furthermore, this alternative is capable of treating both obesity and GERD, in a simple way, avoiding mechanical restriction and the significant malabsorption related to excluded segments.
流行病学数据表明，肥胖是胃食管反流病（GERD）发展的一个重要危险因素。BMI＞30 的患者中，有高达 50%的人出现 GERD 症状。尽管文献中仍存在争议，但有几项研究表明袖状胃切除术（SG）与 GERD 患病率增加有关。本视频展示了一种伴有转流分区（TB）的心包折叠的 SG 技术，用于治疗一名患有严重 GERD 的肥胖患者。
一名 46 岁男性因肥胖和 GERD 症状多年就诊。他的 BMI 为 37.8 kg/m，主要为中心性肥胖，并有几种肥胖相关的合并症，包括高血压、血脂异常、严重胰岛素抵抗和阻塞性睡眠呼吸暂停。经过诊断评估，患者接受了袖状胃切除术和转流分区术。他的体重减轻令人满意，BMI 达到 26，所有合并症均得到缓解，GERD 症状完全缓解。目前的随访期为 2.5 年，患者没有出现体重反弹或 GERD 症状复发。
我们提出了一种有效的手术选择，既能减轻体重，又能缓解 GERD。SG+TB 是治疗代谢综合征和肥胖症的有效方法。此外，这种方法还可以通过一种简单的方式同时治疗肥胖症和 GERD，避免了机械限制和与切除段相关的严重吸收不良。
