腹腔镜下圆韧带心包固定术挽救术；在袖状胃切除术后处理反流中老方法新用途。
Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy.
机构信息
Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA; Beaumont Hospital Grosse Pointe, 468 Cadieux Rd. Grosse Pointe, MI, 48230, USA.
Department of Surgery, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA.
出版信息
Am J Surg. 2021 Mar;221(3):602-605. doi: 10.1016/j.amjsurg.2020.12.036. Epub 2020 Dec 25.
BACKGROUND
Severe reflux after sleeve-gastrectomy (SG) often requires conversion to Roux-en-Y-Gastric Bypass (RYGB). We performed laparoscopic Ligamentum Teres Cardiopexy (LLTC) as an alternative operation.
MATERIALS & METHODS: Ten patients had LLTC between June 2019-June 2020. Pre-operative work-up included Barium swallow, upper endoscopy with pH monitoring. The percent excess body mass index (%EBMI) loss before LLTC was 70 ± 0.2%.
RESULTS
Pre-operative DeMeester score was 69 ± 50 (normal = 14.72). All patients underwent repair of hiatal hernia and gastric plication in addition to LLTC. The average operative-time was 110 ± 26 min. The follow up was 7 ± 3 months. Eight patients had resolution of their reflux. Two patients resumed medication for recurrent mild reflux.
CONCLUSION
LLTC is a safe technique and may be considered a rescue operation in lieu of conversion to RYGB in managing severe reflux after SG. Long term results are needed to confirm its durable effectiveness.
背景
袖状胃切除术后（SG）严重反流常需要转换为 Roux-en-Y 胃旁路术（RYGB）。我们进行了腹腔镜下横膈膜悬韧带固定术（LLTC）作为替代手术。
材料与方法
2019 年 6 月至 2020 年 6 月期间，有 10 例患者接受了 LLTC。术前检查包括钡餐透视、上消化道内镜检查和 pH 监测。LLTC 前的体质量指数超标百分比（%EBMI）损失为 70±0.2%。
结果
术前 DeMeester 评分 69±50（正常为 14.72）。所有患者均行疝修补术和胃折叠术，此外还进行了 LLTC。平均手术时间为 110±26 分钟。随访时间为 7±3 个月。8 例患者反流得到缓解。2 例患者因复发性轻度反流而恢复药物治疗。
结论
LLTC 是一种安全的技术，可作为 SG 后严重反流管理中替代 RYGB 的挽救性手术。需要长期结果来确认其持久有效性。
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