Programa de Unidades Bariátricas, Buenos Aires, Argentina.
GEDYT (Gastroenterología Diagnóstica y Terapéutica), Buenos Aires, Argentina.
J Laparoendosc Adv Surg Tech A. 2022 Feb;32(2):103-110. doi: 10.1089/lap.2020.0999. Epub 2021 Apr 12.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the treatment of choice for obesity with gastroesophageal reflux disease (GERD). There are few reports showing objective data based on esophageal function tests (EFTs). The aim of our study was to evaluate the influence of LRYGB on GERD. Candidates for laparoscopic sleeve gastrectomy (LSG) underwent preoperative esophageal manometry (EM) and 24-hour pH monitoring. Based on the negative influence of LSG on GERD, patients with abnormal pH were offered LRYGB. Those patients repeated EFTs, esophagogastroduodenoscopy, and symptom questionnaire 1 year after surgery. Two hundred fifty LSG candidates underwent preoperative EFTs; 38% were redirected to LRYGB due to abnormal pH and 13 (18%) completed EFTs postoperatively. In ten women, age: 40 ± 7 years, body mass index: 41 ± 1 kg/m. EM: lower esophageal sphincter (LES) length increased from 2.6 to 2.9 cm ( = not statistically significant [NS]), and LES pressure decreased from 15 to 14.2 mmHg ( = NS). Preoperatively, LES was normotensive in 12 (92%) patients and postoperatively in 11 (85%) ( = NS). DeMeester score decreased from 35.7 to 11 ( < .001). Postoperatively, 9 (69%) patients resolved their GERD, 3 (23%) improved, and 1 (8%) remained the same ( < .001). Symptoms decreased significantly after surgery. Two patients (15%) had Grade A esophagitis. One of them was able to resolve it, while the other 1 remained the same. Our preliminary data showed that after LRYGB, LES pressure remained the same and DeMeester score decreased, while 69% of patients resolved their GERD. Therefore, LRYGB seems to be an excellent option for obesity and GERD.
腹腔镜胃旁路手术（LRYGB）被认为是肥胖伴胃食管反流病（GERD）的首选治疗方法。基于食管功能测试（EFT）的客观数据的报告较少。我们的研究旨在评估 LRYGB 对 GERD 的影响。接受腹腔镜袖状胃切除术（LSG）的候选人接受术前食管测压（EM）和 24 小时 pH 监测。由于 LSG 对 GERD 有负面影响，因此对 pH 值异常的患者提供 LRYGB。这些患者在手术后 1 年重复进行 EFT、食管胃十二指肠镜检查和症状问卷。250 名 LSG 候选者接受了术前 EFT；由于 pH 值异常，38%的患者被重新定向到 LRYGB，其中 13 名（18%）患者在术后完成了 EFT。在 10 名女性中，年龄：40 ± 7 岁，体重指数：41 ± 1kg/m。EM：下食管括约肌（LES）长度从 2.6 增加到 2.9cm（无统计学意义[NS]），LES 压力从 15 降低到 14.2mmHg（NS）。术前，12 名（92%）患者的 LES 正常，术后 11 名（85%）患者的 LES 正常（NS）。DeMeester 评分从 35.7 降低到 11（<0.001）。术后，9 名（69%）患者 GERD 得到缓解，3 名（23%）患者改善，1 名（8%）患者保持不变（<0.001）。术后症状明显减轻。2 名患者（15%）患有 A 级食管炎。其中 1 名能够缓解，而另 1 名则保持不变。我们的初步数据显示，LRYGB 后 LES 压力保持不变，DeMeester 评分降低，69%的患者 GERD 得到缓解。因此，LRYGB 似乎是肥胖和 GERD 的绝佳选择。
