Aleman Rene, Lo Menzo Emanuele, Szomstein Samuel, Rosenthal Raul J
Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA.
Ann Transl Med. 2021 May;9(10):899. doi: 10.21037/atm-20-5890.
With the exponential increase of worldwide obesity, the number of bariatric surgery (BaS) procedures have equally risen. The surgical management of obesity has been widely established as the standard of care for sustained weight reduction, resolution, and improvement of associated comorbidities. However, BaS itself can have postoperative deleterious effects, including gastroesophageal reflux disease (GERD) and upper gastrointestinal motility disorders. The modified anatomy resulting from BaS, due to either a restrictive or hypoabsorptive component, gives this disorder a multifactorial etiology. The overall management of GERD should focus on three primordial approaches: Non-surgical, endoluminal, and surgical. Even in the absence of GERD following primary or secondary BaS, said disorder should be closely monitored and therapy should be catered in a case-by-case approach. Consequently, treatment strategies have been developed on this principle as to adequately resolve GERD. Despite the presence of multiple and suitable treatment modalities, the operating surgeon should perform them in the best interest of the patient. Short-, medium-, and long-term outcomes should be taken into consideration prior to proceed with any type of preferred management option. This article herein presents an update on the surgical management of GERD following BaS and current practical innovations.
随着全球肥胖率呈指数级增长,减肥手术(BaS)的数量也同样增加。肥胖的手术治疗已被广泛确立为持续减重、解决并改善相关合并症的护理标准。然而,减肥手术本身可能会产生术后有害影响,包括胃食管反流病(GERD)和上消化道动力障碍。由于减肥手术中存在限制或吸收不良成分,其导致的解剖结构改变使这种疾病具有多因素病因。胃食管反流病的整体管理应集中在三种主要方法上:非手术、腔内治疗和手术治疗。即使在初次或二次减肥手术后没有出现胃食管反流病,也应对该疾病进行密切监测,并应根据具体情况提供治疗。因此,基于这一原则制定了治疗策略,以充分解决胃食管反流病。尽管存在多种合适的治疗方式,但手术医生应从患者的最大利益出发进行操作。在选择任何首选管理方案之前,都应考虑短期、中期和长期结果。本文介绍了减肥手术后胃食管反流病的手术管理及当前的实际创新进展。