Division of Gastroenterology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Fox Chase Cancer Center, Philadelphia, PA, USA.
Surg Endosc. 2023 Jul;37(7):5374-5379. doi: 10.1007/s00464-023-10024-x. Epub 2023 Mar 30.
Laparoscopic sleeve gastrectomy (LSG) has become the most common bariatric procedure due to the technical ease and weight loss success of the operation. However, there has been concern that LSG contributes to gastroesophageal reflux disease (GERD) postoperatively with a proportion of patients requiring conversion to a Roux-En-Y Gastric Bypass (RYGB). The objective of this study was to characterize the patients who underwent revision in our hospital system and to better understand pre-operative predictors of GERD and revision.
After IRB approval, a retrospective review was conducted assessing for patients who had conversion of LSG to RYGB at three hospitals within the University of Pennsylvania Health System from January 2015 to December 2021. The patients' charts were then reviewed to evaluate for demographics, BMI, operative findings, imaging and endoscopic reports, and post-operative outcomes.
97 patients were identified who underwent conversion of LSG to RYGB between January 2015 and December 2021. The cohort was predominantly female (n = 89, 91.7%) with an average age of 42.7 ± 10.6 years at the time of conversion. The most common indications for revision were GERD (72.2%) and obesity/insufficient weight loss (24.7%). Patients lost an average of 11.1 ± 12.9 kg after revision to RYGB. Of the patients who underwent revision for GERD, 80.2% noted global symptomatic improvement after revision and 19.4% were able to stop their proton pump inhibitor (PPI) postoperatively, with most patients decreasing the frequency of the PPI use postoperatively.
The majority of patients who underwent conversion from LSG to RYGB due to GERD and saw marked improvements in GERD symptoms and outcomes. These findings illuminate the real-world practices and outcomes of bariatric revisional procedures for reflux and the need for more research on standardized practice.
腹腔镜袖状胃切除术（LSG）由于手术技术简单和减重效果显著，已成为最常见的减重手术。然而，人们担心 LSG 会导致术后胃食管反流病（GERD），一部分患者需要转为 Roux-en-Y 胃旁路术（RYGB）。本研究的目的是描述在我们医院系统中进行修正的患者，并更好地了解 GERD 和修正的术前预测因素。
在获得机构审查委员会批准后，我们对 2015 年 1 月至 2021 年 12 月期间，宾夕法尼亚大学健康系统的 3 家医院中接受 LSG 转为 RYGB 手术的患者进行了回顾性评估。然后对患者的病历进行了审查，以评估人口统计学、BMI、手术结果、影像学和内镜报告以及术后结果。
共确定了 97 名患者在 2015 年 1 月至 2021 年 12 月期间接受了 LSG 转为 RYGB。该队列主要为女性（n=89，91.7%），在转为 RYGB 时的平均年龄为 42.7±10.6 岁。修正的最常见指征是 GERD（72.2%）和肥胖/体重减轻不足（24.7%）。患者在转为 RYGB 后平均减轻了 11.1±12.9kg。在因 GERD 而接受修正的患者中，80.2%的患者在修正后报告整体症状改善，19.4%的患者在术后能够停止使用质子泵抑制剂（PPI），大多数患者术后减少了 PPI 的使用频率。
大多数因 GERD 而从 LSG 转为 RYGB 的患者在 GERD 症状和结果方面均有显著改善。这些发现阐明了减重修正手术治疗反流的真实世界实践和结果，需要对标准化实践进行更多研究。
