NYU Langone Health/ NYU Grossman School of Medicine, 530 First, Ave., Suite 10S, New York, NY, 10016, USA.
Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA.
Obes Surg. 2021 Mar;31(3):1139-1146. doi: 10.1007/s11695-020-05111-0. Epub 2020 Nov 26.
The laparoscopic sleeve gastrectomy (LSG) has become one of the most popular surgical weight loss options. Since its inception as a procedure intended to promote durable weight loss, the association between LSG and gastroesophageal reflux disease (GERD) has been a point of debate. First and foremost, it is known that GERD occurs more frequently in the obese population. With the sleeve gastrectomy growing to be the predominant primary bariatric operation in the United States, it is imperative that we understand the impact of LSG on GERD.
To examine the effects of LSG on GERD symptoms.
One hundred and ninety-one bariatric surgery candidates completed a Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire before and after undergoing elective LSG (mean follow-up time of 20.4 ± 2.7 months). Values were stratified by the presence or absence of preoperative GERD, GERD medications, age, gender, crural repair, patient satisfaction with present condition, and percent total weight loss (%TWL).
For the entire group, mean weight loss, %TWL, and reduction in BMI were 79 pounds, 28.1%, and 12.7 kg/m respectively. Within the overall cohort, there was no significant change in GERD symptoms from before to after surgery (mean GERD-HRQL scores were 6.1 before and after surgery, p = 0.981). However, in a subgroup analysis, patients without GERD preoperatively demonstrated a worsening in mean GERD-HRQL scores after surgery (from 2.4 to 4.5, p = 0.0020). The percentage of change in the usage of medications to treat GERD was not statistically significant (from 37 to 32%, p = 0.233). The percent of patients satisfied with their condition postoperatively was significantly increased in those with preoperative GERD, older age, crural repair intraoperatively, and in those with the highest %TWL.
These results suggest that while overall LSG does not significantly affect GERD symptoms, patients without GERD preoperatively may be at risk for developing new or worsening GERD symptoms after surgery. It is important to remark that this is a review of the patient's clinical symptoms of GERD, not related to any endoscopic, pathological, or manometry studies. Such studies are necessary to fully establish the effect of LSG on esophageal health.
腹腔镜袖状胃切除术（LSG）已成为最受欢迎的减肥手术之一。自最初作为一种旨在促进持久减肥的手术以来，LSG 与胃食管反流病（GERD）之间的关系一直存在争议。首先，众所周知，肥胖人群中 GERD 更为常见。随着袖状胃切除术在美国成为主要的初级减肥手术，我们必须了解 LSG 对 GERD 的影响。
检查 LSG 对 GERD 症状的影响。
191 名减肥手术候选者在接受择期 LSG 前后完成了胃食管反流病健康相关生活质量（GERD-HRQL）问卷（平均随访时间为 20.4±2.7 个月）。根据术前 GERD、GERD 药物、年龄、性别、胃底折叠术、对当前状况的满意度以及体重减轻百分比（%TWL）的存在与否对值进行分层。
对于整个组，平均体重减轻、%TWL 和 BMI 减少分别为 79 磅、28.1%和 12.7kg/m。在整个队列中，手术前后 GERD 症状没有明显变化（术前平均 GERD-HRQL 评分为 6.1，手术后为 6.1，p=0.981）。然而，在亚组分析中，术前无 GERD 的患者手术后平均 GERD-HRQL 评分恶化（从 2.4 到 4.5，p=0.0020）。用于治疗 GERD 的药物使用百分比变化没有统计学意义（从 37%到 32%，p=0.233）。术前有 GERD、年龄较大、术中进行胃底折叠术以及体重减轻百分比最高的患者术后对自身状况的满意度显著增加。
这些结果表明，尽管总体而言 LSG 并不显著影响 GERD 症状，但术前无 GERD 的患者手术后可能有发生新的或恶化的 GERD 症状的风险。值得注意的是，这是对 GERD 患者临床症状的回顾，与任何内镜、病理或测压研究无关。这些研究对于充分确定 LSG 对食管健康的影响是必要的。
