Balla Andrea, Quaresima Silvia, Palmieri Livia, Seitaj Ardit, Pronio Annamaria, Badiali Danilo, Fingerhut Abe, Ursi Pietro, Paganini Alessandro M
Department of General Surgery and Surgical Specialties "Paride Stefanini" and Sapienza University of Rome, Rome, Italy.
Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
J Laparoendosc Adv Surg Tech A. 2019 Dec;29(12):1532-1538. doi: 10.1089/lap.2019.0540. Epub 2019 Oct 1.
Effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) symptoms are controversial. Our aim is to evaluate the effects of LSG on GERD symptoms in obese patients using a validated quality-of-life questionnaire. Records of 100 patients (median body mass index [BMI] 44.4 kg/m, range 35-63.6) without hiatal hernia or severe GERD were analyzed. GERD symptoms were evaluated by GERD Health-Related Quality-of-Life (HRQL) questionnaire before and after surgery. Weight loss and comorbidity resolution were recorded. Median GERD-HRQL scores decreased from 7 (range 0-44) to 3 (0-34) ( = .025) (median follow-up 56 months [range 7-136]). GERD-HRQL scores improved in 55 patients and worsened in 21; GERD was observed in 10; no change occurred in 14 patients (differences being statistically significant: = <.0001). On multilinear regression analysis, total preoperative GERD-HRQL score and postoperative BMI were independent variables for overall postoperative GERD-HRQL score: higher total preoperative GERD-HRQL score was associated with improved postoperative GERD-HRQL scores, whereas higher postoperative BMI was associated with worse total postoperative GERD-HRQL score. Resolution of diabetes, hypertension, and sleep apnea syndrome occurred in 84.4%, 68%, and 89.7% of patients, respectively. In obese patients, although LSG was associated with statistically significantly improved postoperative GERD-HRQL scores at mid-term follow-up in 55% of patients, only preoperative GERD-HRQL score and postoperative BMI were independent predictors of GERD after LSG. Higher overall preoperative GERD-HRQL score was associated with improved postoperative GERD-HRQL score. However, further research is needed to assess how to predict GERD outcome.
腹腔镜袖状胃切除术（LSG）对lap of laparoscopic sleeve gastrectomy）对胃食管反流病（GERD）症状的影响存在争议。我们的目的是使用经过验证的生活质量问卷评估LSG对肥胖患者GERD症状的影响。分析了100例无食管裂孔疝或严重GERD患者的记录（中位体重指数[BMI]44.4 kg/m，范围35 - 63.6）。术前和术后通过GERD健康相关生活质量（HRQL）问卷评估GERD症状。记录体重减轻和合并症缓解情况。GERD - HRQL中位评分从7（范围0 - 44）降至3（0 - 34）（P = 0.025）（中位随访56个月[范围7 - 136]）。55例患者的GERD - HRQL评分改善，21例恶化；10例观察到GERD；14例患者无变化（差异具有统计学意义：P = <0.0001）。多线性回归分析显示，术前GERD - HRQL总分和术后BMI是术后GERD - HRQL总分的独立变量：术前GERD - HRQL总分越高，术后GERD - HRQL评分改善越明显，而术后BMI越高，术后GERD - HRQL总分越差。分别有84.4%、68%和89.7%的患者糖尿病、高血压和睡眠呼吸暂停综合征得到缓解。在肥胖患者中，尽管LSG在中期随访时使55%的患者术后GERD - HRQL评分有统计学意义的显著改善，但只有术前GERD - HRQL评分和术后BMI是LSG术后GERD的独立预测因素。术前GERD - HRQL总分越高，术后GERD - HRQL评分改善越明显。然而，需要进一步研究以评估如何预测GERD结局。
