General Surgery Unit "M. Rubino," Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
Gastroenterology Unit, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
Surgery. 2022 Sep;172(3):807-812. doi: 10.1016/j.surg.2022.04.040. Epub 2022 Jul 2.
One of the most controversial issues surrounding laparoscopic sleeve gastrectomy is the development of gastroesophageal reflux disease following surgery. The aim of the study was to evaluate the occurrence of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy and to analyze patients' weight loss, comorbidities, and quality of life after surgery.
The clinical records of 52 patients submitted to laparoscopic sleeve gastrectomy between January and November 2018, with 3 years of follow-up, were retrospectively reviewed. At the end of the follow-up period, the patients underwent screening endoscopy, and those with postoperative esophagitis were submitted to endoscopic biopsies and pH-impedance monitoring (MII-pH). The presence of gastroesophageal reflux disease symptoms was assessed using the modified clinical DeMesteer score questionnaire. The Bariatric Analysis and Reporting Outcome System score and 36-Item Short Form Health Survey were used to assess the postoperative quality of life.
In the preoperative work-up, only 7.6% of patients had signs of esophagitis at esophagogastroduodenoscopy, whilst at 3-year follow-up, 50% of them had endoscopic signs of gastroesophageal reflux disease. Twenty-one out of 26 patients with signs of esophagitis agreed to undergo MII-pH. The median DeMesteer score questionnaire was 4.5, with only 4 patients (19%) exhibiting a value greater than the pH cut-off value (14.72), indicative of gastroesophageal reflux disease. MII-pH data analysis showed the presence of gastroesophageal reflux disease in 5 patients. An excellent outcome on the Bariatric Analysis and Reporting Outcome System score was reported in 50% of patients, and all 8 domains from the 36-Item Short Form Health Survey improved significantly.
This study showed an improvement in these patients' quality of life and the limited refluxogenic nature of laparoscopic sleeve gastrectomy at 3-year follow-up when diagnosis of gastroesophageal reflux disease is based on the Lyon consensus.
腹腔镜袖状胃切除术最具争议的问题之一是手术后胃食管反流病的发生。本研究旨在评估腹腔镜袖状胃切除术后胃食管反流病的发生，并分析患者手术后的体重减轻、合并症和生活质量。
回顾性分析了 2018 年 1 月至 11 月期间接受腹腔镜袖状胃切除术的 52 例患者的临床记录，随访时间为 3 年。在随访结束时，患者接受了筛查性内镜检查，术后食管炎患者接受了内镜活检和 pH 阻抗监测（MII-pH）。使用改良的临床 DeMesteer 评分问卷评估胃食管反流病症状的存在。使用减重分析和报告结果系统评分和 36 项简短健康调查问卷评估术后生活质量。
在术前检查中，仅有 7.6%的患者在食管胃十二指肠镜检查时存在食管炎的迹象，而在 3 年随访时，其中 50%的患者有胃食管反流病的内镜迹象。26 例有食管炎迹象的患者中有 21 例同意接受 MII-pH 检查。DeMesteer 评分问卷中位数为 4.5，仅有 4 例（19%）患者的评分大于 pH 截断值（14.72），提示存在胃食管反流病。MII-pH 数据分析显示 5 例患者存在胃食管反流病。50%的患者报告了减重分析和报告结果系统评分的优异结果，所有 36 项简短健康调查问卷的 8 个领域均显著改善。
根据里昂共识，本研究在 3 年随访时显示这些患者的生活质量得到改善，且腹腔镜袖状胃切除术具有有限的反流性，当诊断胃食管反流病时。
