Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes Hôtel-Dieu, Nantes, France.
Chirurgie Cancérologique Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalo-universitaire de Nantes Hôtel-Dieu, Nantes, France; L'institut du thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.
Surg Obes Relat Dis. 2021 Nov;17(11):1890-1896. doi: 10.1016/j.soard.2021.07.012. Epub 2021 Jul 26.
Gastroesophageal reflux disease (GERD) and esophageal motor disorders (EMD) are frequent conditions among patients with obesity. The effects of sleeve gastrectomy (SG) on esophageal function can worsen GERD, but little is known about its effects on EMD and the consequences of preexisting EMD on GERD after SG.
To study the postoperative outcomes of SG in a population of patients displaying preexisting EMD.
University Hospital, France.
Patients with EMD confirmed by high-resolution manometry who underwent a laparoscopic SG between 2010 and 2019 were retrospectively included in this monocenter study. GERD symptoms and high-resolution manometry results were recorded before surgery and during follow-up. Conversion to gastric bypass were also recorded.
Thirty-seven patients were included. Mean age was 52.6 ± 12.9 years. Most patients were female (70%). EMD were achalasia (19% of patients), hypercontractile (22%), hypocontractile (30%) and nutcracker esophagus (22%), and ineffective esophageal motility (8%). GERD symptoms were present in 10 patients (27%) preoperatively and 18 (49%) postoperatively. Achalasia was not resolved after SG and was constantly associated with disabling food blockage or GERD symptoms after surgery, and 3 of 4 patients with nutcracker esophagus had postoperative GERD symptoms and underwent gastric bypass.
This study is the largest to describe the course of GERD and EMD after SG in patients displaying preoperative EMD. Achalasia and nutcracker esophagus are associated with poorer postoperative outcomes, and another procedure such as a gastric bypass should be performed.
胃食管反流病（GERD）和食管动力障碍（EMD）是肥胖患者中常见的病症。袖状胃切除术（SG）对食管功能的影响可能会使 GERD 恶化，但对于 SG 后 EMD 的影响以及 EMD 对 GERD 的后果知之甚少。
研究存在 EMD 的患者接受 SG 后的术后结果。
法国大学医院。
回顾性纳入 2010 年至 2019 年期间因 EMD 经腹腔镜接受 SG 的患者。记录手术前和随访期间的 GERD 症状和高分辨率测压结果。还记录了胃旁路转换的情况。
共纳入 37 例患者。平均年龄为 52.6±12.9 岁。大多数患者为女性（70%）。EMD 为贲门失弛缓症（19%的患者）、高收缩性（22%）、低收缩性（30%）和胡桃夹食管（22%）和无效食管动力（8%）。术前 10 例（27%）和术后 18 例（49%）患者存在 GERD 症状。SG 后贲门失弛缓症未缓解，始终与手术后的严重食物堵塞或 GERD 症状相关，4 例胡桃夹食管中有 3 例术后出现 GERD 症状并接受了胃旁路手术。
本研究是描述术前存在 EMD 的患者接受 SG 后 GERD 和 EMD 病程的最大研究。贲门失弛缓症和胡桃夹食管与较差的术后结果相关，应进行其他手术如胃旁路手术。
