Department of Bariatric and Metabolic Surgery, Ponderas Academic Hospital, Bucharest, Romania.
Titu Maiorescu University Doctoral School of Medicine, Bucharest, Romania.
Surg Endosc. 2023 May;37(5):3747-3759. doi: 10.1007/s00464-022-09829-z. Epub 2023 Jan 19.
Laparoscopic Sleeve Gastrectomy (LSG) is the most attractive bariatric procedure, but the postoperative intrathoracic gastric migration (ITM) and "de novo" GERD are major concerns. The main objective of our study was to evaluate the efficiency of the concomitant HHR with or without partial reconstruction of phreno-esophageal ligament (R-PEL) to prevent ITM after LSG. The secondary objectives focused on procedure's metabolic and GERD-related outcomes.
Consecutive patients who underwent primary LSG and concomitant HHR were included in a single-center prospective study. According to the HHR surgical technique, two groups were analyzed and compared: Group A included patients receiving crura approximation only and Group B patients with R-PEL. The patients' evolution of co-morbidities, GERD symptoms, radiologic, and endoscopic details were prospectively analyzed.
Two hundred seventy-three patients undergoing concurrent HHR and LSG were included in the study (Group A and B, 146 and 127 patients) The mean age and BMI were 42.6 ± 11.3 and 43.4 ± 6.8 kg/m. The 12-month postoperative ITM was radiologically found in more than half of the patients in Group A, while in group B, the GEJ's position appeared normal in 91.3% of the patients, meaning that R-PEL reduced 7 times the rate of ITM. The percentage of no-improvement and "de novo" severe esophagitis (Los Angeles C) was 4 times higher in group A 3.4% vs. 0.8% with statistical significance, and correlated to ITM. The GERD symptoms were less frequent in Group B vs Group A, 21.3% vs 37%, with statistical significance. No Barrett's esophagus and no complication were recorded in any of the patients.
Concurrent LSG and HHR by crura approximation only has a very high rate of ITM in the first postoperative year (over 50%). R-PEL is an innovative technique which proved to be very efficient in preventing the ITM after HHR.
腹腔镜袖状胃切除术（LSG）是最具吸引力的减重手术，但术后胸腔内胃迁移（ITM）和“新发性”GERD 是主要关注点。我们研究的主要目的是评估同时进行 HHR 是否有效，以及是否同时进行膈食管韧带（R-PEL）部分重建以预防 LSG 后 ITM。次要目标侧重于手术的代谢和 GERD 相关结果。
连续接受 LSG 和同时进行的 HHR 的患者被纳入单中心前瞻性研究。根据 HHR 手术技术，分析并比较两组：组 A 包括仅接受胃底折叠术的患者，组 B 包括接受 R-PEL 的患者。前瞻性分析患者并存疾病的演变、GERD 症状、影像学和内镜细节。
273 例同时进行 HHR 和 LSG 的患者被纳入研究（组 A 和组 B，分别为 146 例和 127 例）。平均年龄和 BMI 分别为 42.6±11.3kg/m 和 43.4±6.8kg/m。组 A 中超过一半的患者在术后 12 个月出现放射学 ITM，而在组 B 中，91.3%的患者 GEJ 位置正常，这意味着 R-PEL 将 ITM 的发生率降低了 7 倍。组 A 中无改善和“新发性”严重食管炎（洛杉矶 C 级）的比例高 4 倍（分别为 3.4%和 0.8%，具有统计学意义），且与 ITM 相关。组 B 中 GERD 症状较组 A 少（分别为 21.3%和 37%，具有统计学意义）。没有患者发生巴雷特食管或并发症。
仅通过胃底折叠术同时进行 LSG 和 HHR 的 ITM 率在术后第一年非常高（超过 50%）。R-PEL 是一种创新技术，被证明在预防 HHR 后 ITM 方面非常有效。
