Gastrobese Clinic, Passo Fundo, RS, Brazil.
Hospital São Vicente de Paulo, Passo Fundo, RS, Brazil.
Obes Surg. 2020 Apr;30(4):1360-1367. doi: 10.1007/s11695-019-04286-5.
To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) in patients with obesity.
Patients with class II or III obesity were treated with LSG or LRYGB. Procedure choice was based on patients and surgeon preferences. GERD symptoms, endoscopy, barium swallow X-ray, esophageal manometry, and 24-h pH monitoring were obtained before and 1 year after surgery.
Seventy-five patients underwent surgery (83% female, 39.3 ± 12.1 years, BMI of 41.5 ± 5.1 kg/m): 35 (46.7%) had LSG and 40 (53.3%) LRYGB. LSG patients had lower BMI (40.3 ± 4.0 kg/m vs. 42.7 ± 5.7 kg/m; p = 0.041) and trend toward lower prevalence of GERD (20% vs. 40%; p = 0.061). One year after surgeries, GERD was more frequent in LSG patients (74% vs. 25%; p < 0.001) and all LSG patients with preoperative GERD continue to have GERD postoperatively. De novo GERD occurred in 19 of 28 (67.9%) of LSG patients and 4 of 24 (16.7%) patients treated with LRYGB (OR 10.6, 95%CI 2.78-40.1). Independent predictors for post-operative GERD were as follows: LSG (OR 12.3, 95%CI 2.9-52.5), preoperative esophagitis (OR 8.5, 95% CI 1.6-44.8), and age (OR 2.0, 95%CI 1.1-3.4).
One year after surgery, persistent or de novo GERD were substantially more frequent in patients treated with LSG compared with LRYGB. LSG was the strongest predictor for GERD in our trial. Preoperative counseling and choice of bariatric surgical options must include a detailed assessment and discussion of GERD-related surgical outcomes.
评估腹腔镜袖状胃切除术（LSG）或腹腔镜 Roux-en-Y 胃旁路术（LRYGB）对肥胖患者胃食管反流病（GERD）的影响。
对 II 类或 III 类肥胖患者进行 LSG 或 LRYGB 治疗。手术方式的选择基于患者和外科医生的偏好。在手术前和手术后 1 年，获取 GERD 症状、内镜、钡餐 X 线、食管测压和 24 小时 pH 监测结果。
75 例患者接受了手术（83%为女性，39.3±12.1 岁，BMI 为 41.5±5.1kg/m²）：35 例（46.7%）接受了 LSG，40 例（53.3%）接受了 LRYGB。LSG 患者的 BMI 较低（40.3±4.0kg/m² vs. 42.7±5.7kg/m²；p=0.041），GERD 的患病率呈下降趋势（20% vs. 40%；p=0.061）。手术后 1 年，LSG 患者的 GERD 更为常见（74% vs. 25%；p＜0.001），且所有术前存在 GERD 的 LSG 患者术后仍存在 GERD。28 例 LSG 患者中有 19 例（67.9%）和 24 例 LRYGB 患者中有 4 例（16.7%）新发 GERD（OR 10.6，95%CI 2.78-40.1）。术后 GERD 的独立预测因素如下：LSG（OR 12.3，95%CI 2.9-52.5）、术前食管炎（OR 8.5，95%CI 1.6-44.8）和年龄（OR 2.0，95%CI 1.1-3.4）。
与 LRYGB 相比，LSG 术后 1 年持续或新发 GERD 更为常见。LSG 是本试验中 GERD 的最强预测因素。在进行手术之前，必须对患者进行详细的评估，并讨论与 GERD 相关的手术结果，再进行手术选择。
