Li Jonathan Z, Broderick Ryan C, Huang Estella Y, Serra Joaquin, Wu Samantha, Genz Michael, Sandler Bryan J, Jacobsen Garth R, Horgan Santiago
Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
Surg Endosc. 2023 Apr;37(4):3145-3153. doi: 10.1007/s00464-022-09454-w. Epub 2022 Aug 10.
Post-operative gastroesophageal reflux disease (GERD) remains a significant morbidity following sleeve gastrectomy (SG). We aim to evaluate the incidence and impact within a single center experience.
A retrospective review of a prospectively maintained database was performed identifying laparoscopic or robotic SG patients. Primary outcomes included weight loss, rates of post-operative GERD (de-novo or aggravated), and re-intervention. Subgroup analysis was performed between patients with (Group 1) and without (Group 2) post-operative GERD. De-novo GERD and aggravated was defined as persistent GERD complaints or new/increased PPI usage in GERD naive or prior GERD patients, respectively.
392 patients were identified between 2014 and 2019. Average demographics: age 42.3 (18-84) years, Charlson Comorbidity Index (CCI) 1.12 (0-10), and body mass index (BMI) 47.7 (28-100). 98% were performed laparoscopically. Average excess weight loss (EWL) was 51.0% and 46.4% at 1 and 2 years post-operatively. Average follow up was 516 (6-2694) days. 69 (17%) patients developed post operative de-novo or aggravated GERD. Group 1 had significantly higher EWL at 9 months (57% vs 47%, p 0.003). 13 (3%) patients required operative re-intervention for GERD and other morbidities: 4 RYGB conversions, 4 diagnostic laparoscopies, 3 HHR, 1 MSA placement. Group 1 had higher rates of post-operative intervention (14% vs 1%, p 0.0001). Subanalysis demonstrated that Group 1 had elevated preoperative DeMeester scores on pH testing (34.8 vs 18.9, p 0.03). De-novo GERD had an elevated post-operative total acid exposure when compared to aggravated GERD (12.7% vs 7.0% p 0.03). No significant differences were found between preoperative endoscopy findings, pre and postoperative total acid exposure, post-operative DeMeester scores, and high-resolution manometry values regarding de-novo/aggravated GERD development.
Preoperative DeMeester scores may serve as risk indicators regarding post-operative GERD. Outcomes such as reintervention remain elevated in post-operative GERD patients.
胃食管反流病（GERD）仍是袖状胃切除术（SG）后一种严重的发病情况。我们旨在评估单一中心经验中的发病率及其影响。
对前瞻性维护的数据库进行回顾性分析，确定接受腹腔镜或机器人辅助SG的患者。主要结局包括体重减轻、术后GERD（新发或加重）发生率以及再次干预情况。对有（第1组）和无（第2组）术后GERD的患者进行亚组分析。新发GERD和GERD加重分别定义为在无GERD病史或既往有GERD病史的患者中持续出现GERD症状或新使用/增加质子泵抑制剂（PPI）的用量。
2014年至2019年期间共确定392例患者。平均人口统计学特征：年龄42.3（18 - 84）岁，查尔森合并症指数（CCI）1.12（0 - 10），体重指数（BMI）47.7（28 - 100）。98%的手术为腹腔镜手术。术后1年和2年的平均超重减轻（EWL）分别为51.0%和%。平均随访时间为516（6 - 2694）天。69（17%）例患者发生术后新发或GERD加重。第1组在9个月时的EWL显著更高（57%对47%，p = 0.003）。13（3%）例患者因GERD和其他疾病需要再次手术干预：4例转为Roux-en-Y胃旁路术（RYGB），4例诊断性腹腔镜检查，3例高选择性迷走神经切断术（HHR），1例放置磁珠辅助胃减容装置（MSA）。第1组的术后干预率更高（14%对1%，p = 0.0001）。亚组分析表明，第1组术前pH测试的DeMeester评分升高（34.8对18.9，p = 0.03）。与GERD加重相比，新发GERD术后总酸暴露升高（12.7%对7.0%，p = 0.03）。在术前内镜检查结果、术前和术后总酸暴露、术后DeMeester评分以及关于新发/加重GERD发生的高分辨率测压值方面未发现显著差异。
术前DeMeester评分可作为术后GERD的风险指标。在术后GERD患者中，再次干预等结局仍然较高。
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