ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), Toulon, France; Clinica Madonna della Salute, Department of Digestive and Bariatric Surgery, Porto Viro, Italy.
Clinique Geoffroy-Saint Hilaire, Générale de Santé (GDS), Department of Digestive and Bariatric Surgery, Paris, France.
Surg Obes Relat Dis. 2020 Jun;16(6):732-737. doi: 10.1016/j.soard.2020.02.009. Epub 2020 Feb 22.
The main side effect of long-term laparoscopic sleeve gastrectomy is the onset of severe gastroesophageal reflux disease (GERD).
The aim of this study was to evaluate the effectiveness of gastric bypass conversion in controlling postsleeve GERD.
University Hospital and Private Hospital, France and Private Hospital, Italy.
This retrospective multicenter study included patients who underwent laparoscopic sleeve gastrectomy and suffered from postoperative GERD, who did not respond to medical treatment and were converted to laparoscopic Roux-en-Y gastric bypass. The study involved 2 French university hospitals, 4 French private centers, and an Italian public hospital.
A total of 80 patients were reviewed. Treatment of a hiatal hernia was performed during laparoscopic sleeve gastrectomy in 3 patients, while 19 patients were operated for hiatal hernia during conversion to bypass (P = .0004). Six months after surgery, 23 of 80 patients maintained reflux symptomatology with a daily frequency, for which continued proton pump inhibitor treatment was required. The persistence of GERD was significantly more frequent among patients with previous gastric banding (n = 19) compared with patients with no history of gastric banding (n = 4, P = .02). In other words, the likelihood of having poor clinical success from conversion of the sleeve to bypass because of intractable GERD was 3 times higher if the patient had a history of gastric banding (relative risk = 2.89, odds ratio = 3.69).
The results of this study show that, despite the conversion, the symptomatology of GERD does not always disappear, especially in patients with previous gastric banding.
长期腹腔镜袖状胃切除术的主要副作用是严重胃食管反流病（GERD）的发生。
本研究旨在评估胃旁路转换术控制袖状胃切除术后 GERD 的效果。
法国的大学医院和私人医院，以及意大利的私人医院。
这项回顾性多中心研究纳入了接受腹腔镜袖状胃切除术并患有术后 GERD 的患者，这些患者对药物治疗无反应，并已转换为腹腔镜 Roux-en-Y 胃旁路术。该研究涉及法国的 2 家大学医院、4 家法国私人中心和一家意大利公立医院。
共回顾了 80 例患者。在 3 例患者中，腹腔镜袖状胃切除术时进行了食管裂孔疝治疗，而在 19 例患者中转旁路手术时进行了食管裂孔疝治疗（P =.0004）。80 例患者中有 23 例在手术后 6 个月仍有反流症状，每日发作，需要继续质子泵抑制剂治疗。与无胃带病史的患者（n = 4）相比，先前有胃带病史的患者（n = 19）持续性 GERD 的发生率明显更高（P =.02）。换句话说，如果患者有胃带病史，由于难治性 GERD 而将袖套转换为旁路手术的临床成功率较差的可能性要高 3 倍（相对风险 = 2.89，优势比 = 3.69）。
本研究结果表明，尽管进行了转换，但 GERD 的症状并不总是消失，尤其是在有先前胃带病史的患者中。
Zotero 插件