量化机器人袖状胃切除术中胃食管交界处的生理参数并识别袖状胃切除术后胃食管反流病的预测因素。
Quantifying physiologic parameters of the gastroesophageal junction during robotic sleeve gastrectomy and identifying predictors of post-sleeve gastroesophageal reflux disease.
作者信息
Greenberg Jacques A, Palacardo Federico, Edelmuth Rodrigo C L, Egan Caitlin E, Lee Yeon Joo, Dakin Gregory, Zarnegar Rasa, Afaneh Cheguevara, Bellorin Omar
机构信息
Department of Surgery, Division of Endocrine & Minimally Invasive Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
Department of Surgery, Division of Gastrointestinal Metabolic & Bariatric Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 520 East 70th Street, Starr Pavillion, 8th Floor, New York, NY, 10021, USA.
出版信息
Surg Endosc. 2023 Feb;37(2):1543-1550. doi: 10.1007/s00464-022-09450-0. Epub 2022 Jul 20.
BACKGROUND
Sleeve gastrectomy is among the most commonly-performed procedures for morbid obesity. However, patients occasionally develop post-sleeve gastroesophageal reflux disease (GERD). Identifying patients most at risk for this complication remains difficult. We aimed to correlate intra-operative physiologic measurements of the lower esophageal sphincter (LES) at the gastroesophageal junction (GEJ) during robotic sleeve gastrectomy in an attempt to identify predictors of post-sleeve GERD symptoms.
METHODS
A retrospective chart review of a prospectively maintained database identified 28 patients in whom robotic sleeve gastrectomy was performed utilizing EndoFLIP™ technology between January and September 2021. Intraoperative LES measurements at the GEJ including cross-sectional area (CSA), distensibility index (DI), intra-balloon pressure, and high-pressure zone (HPZ length) were correlated with post-operative GERD.
RESULTS
GEJ CSA, pressure, and DI increased over the course of the surgery (CSA pre-op: 31 (IQR 19.3-39.5) mm vs. post-op: 67 (IQR 40.8-95.8) mm, p < 0.001; pressure: 25.8 (IQR 20.2-33.1) mmHg vs. 31.5 (IQR 28.9-37.0) mmHg, p = 0.007; DI 1.1 (IQR 0.8-1.8) mm/mmHg vs. 2.0 (IQR 1.2-3.0) mm/mmHg, p = < 0.001), whereas HPZ length decreased (2.5 (IQR 2.5-3) cm vs. 2.0 (IQR 1.3-2.5) cm, p = 0.022). Twenty-three patients (82.1%) completed a post-operative GERD questionnaire. Fifteen (65.2%) had no GERD symptoms before or after surgery; 5 (21.7%) reported new post-sleeve GERD symptoms; 3 (13.0%) reported exacerbation of pre-existing GERD symptoms. Patients with new or worsening GERD symptoms had higher post-sleeve DIs (3.2 (IQR 1.9-4.5) mm/mmHg vs. 1.5 (IQR 1.2-2.4) mm/mmHg, p = 0.024) and lower post-sleeve LES pressures (29.9 (IQR 26.3-32.9) mmHg vs. 35.2 (IQR 31.0-38.0) mmHg, p = 0.023) than those without.
CONCLUSIONS
An increase in GEJ CSA, pressure, and DI, and a decrease in GEJ length can be expected during robotic sleeve gastrectomy. Patients with new or worsening post-sleeve GERD symptoms have higher post-sleeve DI and lower post-sleeve LES pressure than their asymptomatic counterparts.
背景
袖状胃切除术是治疗病态肥胖最常用的手术之一。然而，患者偶尔会发生袖状胃切除术后胃食管反流病（GERD）。确定最易发生这种并发症的患者仍然很困难。我们旨在关联机器人袖状胃切除术中胃食管交界处（GEJ）下食管括约肌（LES）的术中生理测量值，以试图确定袖状胃切除术后GERD症状的预测因素。
方法
对一个前瞻性维护的数据库进行回顾性图表审查，确定了28例在2021年1月至9月期间使用EndoFLIP™技术进行机器人袖状胃切除术的患者。GEJ处术中LES测量值，包括横截面积（CSA）、扩张性指数（DI）、球囊内压力和高压区（HPZ长度），与术后GERD相关。
结果
手术过程中GEJ的CSA、压力和DI增加（术前CSA：31（四分位间距19.3 - 39.5）mm，术后：67（四分位间距40.8 - 95.8）mm，p < 0.001；压力：25.8（四分位间距20.2 - 33.1）mmHg，对31.5（四分位间距28.9 - 37.0）mmHg，p = 0.007；DI 1.1（四分位间距0.8 - 1.8）mm/mmHg，对2.0（四分位间距1.2 - 3.0）mm/mmHg，p = < 0.001），而HPZ长度减少（2.5（四分位间距2.5 - 3）cm，对2.0（四分位间距1.3 - 2.5）cm，p = 0.022）。23例患者（82.1%）完成了术后GERD问卷调查。15例（65.2%）在手术前后均无GERD症状；5例（21.7%）报告有新的袖状胃切除术后GERD症状；3例（13.0%）报告原有GERD症状加重。有新的或加重的GERD症状的患者术后DI较高（3.2（四分位间距1.9 - 4.5）mm/mmHg，对1.5（四分位间距1.2 - 2.4）mm/mmHg，p = 0.024），术后LES压力较低（29.9（四分位间距26.3 - 32.9）mmHg，对35.2（四分位间距31.0 - 38.0）mmHg，p = 0.023）。
结论
机器人袖状胃切除术中可预期GEJ的CSA、压力和DI增加，GEJ长度减少。有新的或加重的袖状胃切除术后GERD症状的患者比无症状的患者术后DI更高，术后LES压力更低。
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