General and Digestive Surgery Department, Vall d'Hebron Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
Obes Surg. 2021 Sep;31(9):4100-4106. doi: 10.1007/s11695-021-05541-4. Epub 2021 Jul 5.
Sleeve gastrectomy (SG) has become one of the most performed bariatric procedures worldwide. Its main weaknesses are weight regain and gastroesophageal reflux disease (GERD). Conversion to Roux-en-Y gastric bypass (RYGB) is considered the gold standard to manage GERD and related symptoms.
Retrospective evaluation from a prospective bariatric surgery database of all our institution's patients converted from SG to RYGB due to GERD between January 2010 and December 2018. Clinical characteristics and workups before SG and before and after RYGB were analyzed.
During the study period, 35 patients needed a conversion to RYGB, due to GERD or GERD-related symptoms. Mean age was 48.6 years, 85.7% were women, and mean BMI was 31.4 kg/m. The interval between SG and RYGB was in a range 7 to 70 months (mean 33 months). All conversions were completed laparoscopically, associating a hiatoplasty in 45.7% of cases. A complete remission of symptoms was observed in 74% of patients, some improvement in 20%, and no relief in 6%. There were 3 cases of hiatal hernia persistence and 2 of recidivism. Only 1 patient presented pathological pHmetry, while moderate esophagitis was demonstrated in 2 patients.
Conversion to RYGB was effective in almost all patients. Pathological acid exposure and hiatal hernias seem to be the main findings prior to conversion, justifying an exhaustive examination and aggressive approach to the hiatus. Due to the insufficient correlation between symptoms and findings on morphological and functional tests, actively searching for signs of GERD is advisable.
袖状胃切除术（SG）已成为全球施行最多的减重手术之一。其主要缺点是体重反弹和胃食管反流病（GERD）。将 SG 转换为 Roux-en-Y 胃旁路术（RYGB）被认为是治疗 GERD 和相关症状的金标准。
对 2010 年 1 月至 2018 年 12 月期间因 GERD 而在我院接受 SG 转换为 RYGB 的所有患者的前瞻性减重手术数据库进行回顾性评估。分析了 SG 前、RYGB 前和 RYGB 后的临床特征和检查结果。
在研究期间，由于 GERD 或 GERD 相关症状，有 35 例患者需要转换为 RYGB。平均年龄为 48.6 岁，85.7%为女性，平均 BMI 为 31.4kg/m2。SG 和 RYGB 之间的间隔时间为 7 至 70 个月（平均 33 个月）。所有转换均通过腹腔镜完成，其中 45.7%的病例联合进行了食管裂孔修补术。74%的患者症状完全缓解，20%的患者症状有所改善，6%的患者无缓解。有 3 例食管裂孔疝持续存在，2 例复发。仅 1 例患者存在病理性 pH 监测结果，2 例患者存在中度食管炎。
RYGB 转换对几乎所有患者均有效。病理性胃酸暴露和食管裂孔疝似乎是转换前的主要发现，这需要对裂孔进行彻底检查和积极处理。由于症状与形态和功能检查结果之间的相关性不足，积极寻找 GERD 的迹象是可取的。
