Palermo Mariano, Serra Edgardo, Duza Guillermo
Division of Bariatric Surgery, Centro CIEN - DIAGNOMED, Affiliated to the University of Buenos Aires, Buenos Aires, Argentina.
Arq Bras Cir Dig. 2019 Dec 20;32(4):e1482. doi: 10.1590/0102-672020190001e1482. eCollection 2019.
Obesity represents a growing threat to population health all over the world. Laparoscopic sleeve gastrectomy induces alteration of the esophagogastric angle due to surgery itself, hypotony of the lower esophageal sphincter after division of muscular sling fibers, decrease of the gastric volume and, consequently, increase of intragastric pressure; that's why some patients have reflux after sleeve.
To describe a technique and preliminary results of sleeve gastrectomy with a Nissen fundoplication, in order to decrease reflux after sleeve.
In the current article we describe the technique step by step mostly focused on the creation of the wrap and it care.
This procedure was applied in a case of 45 BMI female of 53 years old, with GERD. An endoscopy was done demonstrating a hiatal hernia, and five benign polyps. A Nissen sleeve was performed due to its GERD, hiatal hernia and multiple polyps on the stomach. She tolerated well the procedure and was discharged home uneventfully 48 h after.
N-sleeve is a feasible and safe alternative in obese patients with reflux and hiatal hernia when Roux-en-Y gastric bypass it is not indicated.
肥胖对全球人口健康构成日益严重的威胁。腹腔镜袖状胃切除术由于手术本身会导致食管胃角改变，切断肌肉吊带纤维后食管下括约肌张力降低，胃容积减小，从而导致胃内压升高；这就是为什么一些患者在接受袖状胃切除术后会出现反流。
描述一种联合Nissen胃底折叠术的袖状胃切除术技术及初步结果，以减少袖状胃切除术后的反流。
在本文中，我们逐步描述该技术，主要侧重于胃底折叠术的构建及其注意事项。
该手术应用于一名53岁、BMI为45的患有胃食管反流病（GERD）的女性患者。内镜检查显示有食管裂孔疝和五个良性息肉。由于该患者患有GERD、食管裂孔疝和胃多发息肉，故实施了Nissen袖状胃切除术。她对手术耐受性良好，术后48小时顺利出院。
当不适合行Roux-en-Y胃旁路术时，Nissen袖状胃切除术对于伴有反流和食管裂孔疝的肥胖患者是一种可行且安全的选择。
