Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China.
Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Urumqi, Xinjiang Uygur Autonomous Region, China.
Front Endocrinol (Lausanne). 2022 Nov 18;13:1041889. doi: 10.3389/fendo.2022.1041889. eCollection 2022.
The worsening of gastroesophageal reflux disease (GERD) and "" GERD after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the patient's quality of life; the incidence of GERD after LSG is up to 35%. Laparoscopic sleeve gastrectomy with fundoplication (LSGFD) is a new procedure which is considered to be better for patients with morbid obesity and GERD, but there is a lack of objective evidence to support this statement. This study aimed to assess the effectiveness, safety, and results of LSG and LSGFD on patients who were morbidly obese with or without GERD over an average of 34 months follow-up.
Fifty-six patients who were classified as obese underwent surgery from January 2018 to January 2020. Patients who were obese and did not have GERD underwent LSG and patients who were obese and did have GERD underwent LSFGD. The minimum follow-up time was 22 months and there were 11 cases lost during the follow-up period. We analyzed the short-term complications and medium-term results in terms of weight loss, incidence of GERD/resolution of GERD, and remission of co-morbidities with follow-up.
A total of 45 patients completed the follow-up and a questionnaire-based evaluation (GERD-Q), of whom 23 patients underwent LSG and 22 patients underwent LSGFD. We had 1 case of leak after LSGFD.No medium or long- term complications. The patient's weight decreased from an average of 111.6 ± 11.8 Kg to 79.8 ± 12.2 Kg ( = 0.000) after LSG and from 104.3 ± 17.0 Kg to 73.7 ± 13.1 Kg ( = 0.000) after LSGFD. The GERD-Q scores increased from 6.70 ± 0.5 to 7.26 ± 1.7 (P = 0.016) after LSG and decreased from 8.86 ± 1.3 to 6.45 ± 0.8 ( = 0.0004) after LSGFD. The incidence of GERD after LSG was 12 (52.2%) at the 12 month follow-up and 7 (30.4%) at the mean 34 (22-48) month follow-up. The remission of reflux symptoms, for patients who underwent LSGFD, was seen in 19 (86.4%) of 22 patients at 12 months and 20 (90.9%) of 22 patients at the mean 34 (22-48) month follow-up. The two groups did not have any significant difference in the effect of weight reduction and comorbidity resolution.
The incidence of GERD after LSG is high,LSG resulted in the same weight loss and comorbidity resolution as LSGFD, in patients who are morbidly obese and experience GERD, and LFDSG prevent the occurrence and development of GERD, combination of LSG with fundoplication (LSGFD) is a feasible and safe procedure with good postoperative results,which worthy of further clinical application.
胃食管反流病（GERD）的恶化和“腹腔镜袖状胃切除术（LSG）后的 GERD 是一个主要问题，因为它会影响患者的生活质量；LSG 后 GERD 的发生率高达 35%。腹腔镜袖状胃切除术加胃底折叠术（LSGFD）是一种新的手术方法，被认为对肥胖症和 GERD 患者更有利，但缺乏客观证据支持这一说法。本研究旨在评估 LSG 和 LSGFD 在平均 34 个月的随访中对肥胖症合并或不合并 GERD 的患者的有效性、安全性和结果。
56 名肥胖患者于 2018 年 1 月至 2020 年 1 月接受手术。肥胖且无 GERD 的患者接受 LSG，肥胖且有 GERD 的患者接受 LSGFD。最短随访时间为 22 个月，随访期间有 11 例失访。我们分析了短期并发症和中期结果，包括体重减轻、GERD 的发生率/缓解、合并症的缓解，并进行了随访。
共有 45 名患者完成了随访和基于问卷的评估（GERD-Q），其中 23 名患者接受了 LSG，22 名患者接受了 LSGFD。我们有 1 例 LSGFD 术后漏。无中、长期并发症。患者体重从 LSG 前平均 111.6±11.8kg 降至 79.8±12.2kg（ = 0.000），LSGFD 前从 104.3±17.0kg 降至 73.7±13.1kg（ = 0.000）。LSG 后 GERD-Q 评分从 6.70±0.5 增加到 7.26±1.7（P = 0.016），LSGFD 后从 8.86±1.3 降低到 6.45±0.8（ = 0.0004）。LSG 后 12 个月 GERD 的发生率为 12 例（52.2%），平均 34（22-48）个月随访时为 7 例（30.4%）。LSGFD 术后 12 个月有 19 例（86.4%）患者反流症状缓解，22 例患者中有 20 例（90.9%）患者在平均 34（22-48）个月随访时缓解。两组在减轻体重和缓解合并症方面没有显著差异。
LSG 后 GERD 的发生率较高，LSG 导致肥胖合并 GERD 患者的体重减轻和合并症缓解与 LSGFD 相同，LSFDSG 可预防 GERD 的发生和发展，LSG 联合胃底折叠术（LSGFD）是一种可行且安全的手术方法，具有良好的术后效果，值得进一步临床应用。
