Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Institut des Maladies de l'Appareil Digestif (IMAD), Centre Hospitalier Universitaire (CHU) Nantes-Hôtel Dieu, Nantes, France.
Institut des Maladies de l'Appareil Digestif, IMAD, CHU Nantes, Hopital Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes, France.
Obes Surg. 2020 Apr;30(4):1468-1472. doi: 10.1007/s11695-019-04335-z.
Sleeve gastrectomy is the most commonly performed bariatric surgery these days but is associated with de novo reflux.
We aimed to study the influence of hypotonic lower esophageal sphincter (LES) on postoperative gastroesophageal reflux disease (GERD).
Patients with pre- and postoperative esophageal high-resolution manometry (HRM) and 24-h pH monitoring (pHM) were included retrospectively in our study. Preoperative hypotonic LES was defined by a mean residual pressure of the lower esophageal sphincter < 4 mmHg. Postoperative GERD was defined by a DeMeester's score > 14.72. We also evaluated postoperative manometric changes at the esophageal-gastric junction.
Sixty-nine patients (54 females and 15 males) had pre- and postoperative HRM and pHM. The mean age was 45.9 ± 9.8 years. The mean body mass index (BMI) was 47.5 ± 7.5 kg/m. Hypotonic LES concerned 21 patients (30.4%) before sleeve gastrectomy. The mean time between the two esophageal monitorings was 32.1 ± 24.1 months. The sensitivity, specificity, positive predictive value, and negative predictive value of hypotonic LES to predict GERD were 31, 70, 52, and 48% respectively. The LES minimal residual pressure was not statistically decreased after sleeve gastrectomy (p = 0.24). Only the wave speed, esophageal length, and LES length were significantly reduced after SG (p = 0.029, 3.8 × 10 and 0.00032).
Hypotonic LES has a poor predictive value on postoperative GERD. The LES's length is significantly reduced after SG and this could be a factor explaining de novo reflux.
袖状胃切除术是目前最常施行的减重手术，但与新发性胃食管反流有关。
我们旨在研究低张性下食管括约肌（LES）对术后胃食管反流病（GERD）的影响。
我们回顾性纳入了具有食管高分辨率测压（HRM）和 24 小时 pH 监测（pHM）术前和术后资料的患者。术前低张性 LES 定义为 LES 平均残余压 <4mmHg。术后 GERD 定义为 DeMeester 评分 >14.72。我们还评估了食管胃交界处的术后测压变化。
69 例患者（54 例女性和 15 例男性）具有 HRM 和 pHM 的术前和术后资料。平均年龄为 45.9±9.8 岁。平均体重指数（BMI）为 47.5±7.5kg/m。袖状胃切除术前行 LES 低张的患者有 21 例（30.4%）。两次食管监测之间的平均时间为 32.1±24.1 个月。术前 LES 低张预测 GERD 的敏感性、特异性、阳性预测值和阴性预测值分别为 31%、70%、52%和 48%。袖状胃切除术后 LES 最小残余压无统计学降低（p=0.24）。仅波速、食管长度和 LES 长度在 SG 后显著降低（p=0.029、3.8×10 和 0.00032）。
低张性 LES 对术后 GERD 的预测价值较差。SG 后 LES 长度明显缩短，这可能是新发性反流的一个因素。
