Karila-Cohen Pascale, Pelletier Anne-Laure, Saker Loukbi, Laouénan Cédric, Bachelet Delphine, Khalil Antoine, Arapis Konstantinos
Department of Radiology, Bichat-Claude Bernard University Hospital, Paris, France.
Department of Hepato-Gastro-Enterology, Bichat-Claude Bernard University Hospital, Paris, France.
Obes Surg. 2022 Jul;32(7):1-9. doi: 10.1007/s11695-022-06074-0. Epub 2022 May 2.
Migration of the staple line is the definition of sliding hiatus hernia in sleeve gastrectomy patients. The main aim was to determine the frequency and measurement of intrathoracic staple line migration and its correlation with GERD symptoms and pH monitoring.
This was a prospective clinical trial including all patients who underwent sleeve gastrectomy more than 1 year previously. All the patients underwent computed tomography (CT) imaging, and migration of the proximal end of the suture above the level of the hiatus was measured in mm. All the patients with symptoms suggestive of GERD were assessed using the GERD impact scale (GIS), and wireless 24-h esophageal pH and symptom association monitoring (SAP) were carried out. Analysis of risk factors for postoperative staple line migration was performed.
Between March 2018 and December 2018, 194 patients were evaluated (mean age 45.1 ± 11.2 years; 161 females); 88/194 (45.4%) presented an average intrathoracic migration of 16.2 ± 6.9 mm. Thirty-eight of 194 (19.5%) patients presented symptoms suggestive of gastroesophageal reflux. There was a significant relationship between staple line intrathoracic migration and postsleeve GERD symptomatology (p = 0.0004, OR = 4.25 [1.92-9.39]). However, there was no significant correlation between positive 24-h pH monitoring and intrathoracic migration of the staple line (p = 0.1).
A migration greater than 17 mm was strongly correlated with postsleeve GERD symptoms but not with positive 24-h pH monitoring.
在袖状胃切除患者中，吻合钉线移位是滑动性食管裂孔疝的定义。主要目的是确定胸腔内吻合钉线移位的频率和测量值，及其与胃食管反流病（GERD）症状和pH监测的相关性。
这是一项前瞻性临床试验，纳入所有1年多前接受袖状胃切除术的患者。所有患者均接受计算机断层扫描（CT）成像，测量裂孔水平以上缝线近端的移位，以毫米为单位。所有有GERD症状的患者使用GERD影响量表（GIS）进行评估，并进行无线24小时食管pH和症状关联监测（SAP）。对术后吻合钉线移位的危险因素进行分析。
2018年3月至2018年12月，评估了194例患者（平均年龄45.1±11.2岁；161例女性）；88/194（45.4%）患者胸腔内平均移位16.2±6.9毫米。194例患者中有38例（19.5%）出现胃食管反流症状。吻合钉线胸腔内移位与袖状胃切除术后GERD症状之间存在显著相关性（p = 0.0004，OR = 4.25 [1.92 - 9.39]）。然而，24小时pH监测阳性与吻合钉线胸腔内移位之间无显著相关性（p = 0.1）。
移位大于17毫米与袖状胃切除术后GERD症状密切相关，但与24小时pH监测阳性无关。
