Lexington Surgery, Lexington Medical Center, 146 East Hospital Drive, Suite 400, West Columbia, SC, 29169, USA.
Obes Surg. 2023 Jan;33(1):379-386. doi: 10.1007/s11695-022-06352-x. Epub 2022 Nov 10.
Gastroesophageal reflux disease (GERD) is a significant complication of sleeve gastrectomy (SG). Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is considered the primary treatment for bariatric surgery candidates with GERD. Post-operative options for GERD management are limited. This study compares the effect of transoral fundoplication (TF) prior to SG vs LRYGB in patients with GERD .
Of 30 consecutive bariatric surgery patients with GERD between 3/22/2018 and 6/23/2020, 15 patients underwent TF prior to SG (TF/SG) and 15 patients underwent LRYGB. Subjective and objective criteria, including the GERD Health-Related Quality of Life (HRQL) and Reflux Symptom Index (RSI) survey, were used to assess symptoms. Surveys were collected pre-operatively, post-TF/pre-SG, 4-6 and 12-15 months post bariatric procedure.
Preoperative mean scores were as follows: HRQL 32.53, RSI 21.7, 93% proton pump inhibitor (PPI) usage, 6.5% satisfaction rate. Mean BMI: 45.99 (TF/SG), 42.27 (LRYGB). At 12-15 months postoperatively: mean HRQL scores were 5.53 (TF/SG) and 6.67 (LRYGB). Both groups had a statistically significant improvement in HRQL-RSI postoperatively. PPI usage was 13% (TF/SG) and 34% (LRYGB). BMI decrease was 24% (TF/SG) and 31% (LRYGB).
TF/SG is at least equivalent to LRYGB in resolution or reduction of reflux symptoms at 12-15 months.
胃食管反流病（GERD）是袖状胃切除术（SG）的一个重要并发症。腹腔镜Roux-en-Y 胃旁路术（LRYGB）被认为是 GERD 肥胖症手术患者的主要治疗方法。术后 GERD 管理的选择有限。本研究比较了术前行经口胃底折叠术（TF）与 LRYGB 对 GERD 患者的影响。
在 2018 年 3 月 22 日至 2020 年 6 月 23 日期间，对 30 例连续的 GERD 肥胖症手术患者进行研究，其中 15 例患者在 SG 前行 TF（TF/SG），15 例患者行 LRYGB。采用 GERD 健康相关生活质量（HRQL）和反流症状指数（RSI）调查等主观和客观标准评估症状。在术前、TF/SG 术前、4-6 个月和 12-15 个月时收集调查结果。
术前平均评分如下：HRQL 32.53，RSI 21.7，93%质子泵抑制剂（PPI）使用率，6.5%满意度。平均 BMI：TF/SG 组为 45.99，LRYGB 组为 42.27。术后 12-15 个月：TF/SG 组平均 HRQL 评分为 5.53，LRYGB 组为 6.67。两组术后 HRQL-RSI 均有统计学显著改善。PPI 使用率分别为 13%（TF/SG）和 34%（LRYGB）。BMI 降低分别为 24%（TF/SG）和 31%（LRYGB）。
在 12-15 个月时，TF/SG 在缓解或减少反流症状方面至少与 LRYGB 相当。
