Department of Surgery, Wayne State University/Detroit Medical Center, Detroit, MI; Department of Surgery, NorthShore University Health System, Evanston, IL.
Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, NorthShore University HealthSystem, University of Chicago Medical Center, Chicago, IL.
Surgery. 2024 Mar;175(3):587-591. doi: 10.1016/j.surg.2023.10.031. Epub 2023 Dec 27.
BACKGROUND: Roux-en-Y gastric bypass and fundoplication are effective treatments for gastroesophageal reflux disease, though the optimal procedure of choice in obesity is unknown. We hypothesize that Roux-en-Y gastric bypass is non-inferior to fundoplication for symptomatic control of gastroesophageal reflux disease in patients with obesity. METHODS: We conducted a retrospective review of a prospectively maintained quality database. Patients with a body mass index ≥of 35 who presented for gastroesophageal reflux disease and subsequently underwent Roux-en-Y gastric bypass or fundoplication were included. Perioperative outcomes and pH testing data were reviewed. Patient-reported outcomes included Reflux Symptom Index, Dysphagia, Gastroesophageal Reflux Disease-Health Related Quality of Life, and Short Form-36 scores. Data were analyzed using the Wilcoxon rank sum test. RESULTS: Ninety-five patients underwent fundoplication (n = 72, 75.8%) or Roux-en-Y gastric bypass (n = 23, 24.2%) during the study period. All patients saw an improvement in gastroesophageal reflux disease symptoms and overall quality of life. There were no significant differences in postoperative Reflux Symptom Index, Dysphagia, or Short-Form-36 scores. Significant differences in gastroesophageal reflux disease-Health Related Quality of Life scores were seen at preoperative, 1, 2, and 5 years postoperative (P < .05), with better symptom control in the fundoplication group. No significant difference was noted in postoperative DeMeester scores or percent time pH <4. Weight loss was significantly higher in the Roux-en-Y gastric bypass group at all postoperative time points up to 5 years (P < .05). CONCLUSION: Roux-en-Y gastric bypass and fundoplication both decrease gastroesophageal reflux disease symptoms. Subjective data shows that patients undergoing Roux-en-Y gastric bypass may complain of worse symptoms compared to patients undergoing fundoplication. Objective data notes no significant difference in postoperative pH testing. Despite previous data, offering fundoplication or Roux-en-Y gastric bypass to patients with a body mass index of ≥35 kg/m is appropriate. The choice of surgical approach should be more directed to patient needs and desired goals at the time of the initial clinic visit.
背景：Roux-en-Y 胃旁路术和胃底折叠术是治疗胃食管反流病的有效方法，尽管肥胖症的最佳选择程序尚不清楚。我们假设 Roux-en-Y 胃旁路术在肥胖症患者胃食管反流病症状控制方面不劣于胃底折叠术。
方法：我们进行了一项前瞻性维护质量数据库的回顾性研究。纳入因胃食管反流病就诊并随后接受 Roux-en-Y 胃旁路术或胃底折叠术的 BMI≥35 的患者。回顾了围手术期结果和 pH 检测数据。患者报告的结果包括反流症状指数、吞咽困难、胃食管反流病健康相关生活质量和短格式-36 评分。使用 Wilcoxon 秩和检验分析数据。
结果：在研究期间，95 例患者接受了胃底折叠术（n=72，75.8%）或 Roux-en-Y 胃旁路术（n=23，24.2%）。所有患者的胃食管反流病症状和整体生活质量均得到改善。术后反流症状指数、吞咽困难或短格式-36 评分无显著差异。胃食管反流病健康相关生活质量评分在术前、术后 1、2 和 5 年有显著差异（P<.05），胃底折叠组症状控制更好。术后 DeMeester 评分或 pH<4 的时间百分比无显著差异。Roux-en-Y 胃旁路术组在所有术后时间点至 5 年的体重减轻均显著高于胃底折叠术组（P<.05）。
结论：Roux-en-Y 胃旁路术和胃底折叠术均可减轻胃食管反流病症状。主观数据显示，与接受胃底折叠术的患者相比，接受 Roux-en-Y 胃旁路术的患者可能会抱怨更严重的症状。术后 pH 检测无显著差异。尽管有先前的数据，但对于 BMI≥35kg/m 的患者，提供胃底折叠术或 Roux-en-Y 胃旁路术是合适的。手术方法的选择应更多地针对患者在初次就诊时的需求和期望目标。
Surg Obes Relat Dis. 2009
Curr Opin Gastroenterol. 2025-7-1
Zotero 插件