Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
Policlinica Itaipava, 12.235 Estarda Uniao e Industria, Petropolis, RJ, Brazil.
Obes Surg. 2024 Apr;34(4):1232-1237. doi: 10.1007/s11695-024-07103-w. Epub 2024 Feb 26.
Obesity is a well-known risk factor for gastroesophageal reflux disease (GERD). Even though symptoms may be mitigated or resolved with the weight loss caused by sleeve gastrectomy (SG), it may be associated with higher incidences of postoperative GERD. Ligamentum teres cardiopexy (LTC) is an alternative to Roux-en-Y gastric bypass, the gold standard treatment for GERD.
This study was a retrospective single-center chart review, all patients in this cohort underwent LTC to treat refractory GERD at our institution. The option for LTC was presented after patients' refusal to undergo RYGB conversion. We collected baseline characteristics, standard demographics, pre-operative tests and imaging, and SG information, as well as intraoperative and perioperative data regarding LTC, and postoperative complications.
Our cohort included 29 patients; most were Caucasian (44.8%) females (86.2%). The mean weight and BMI before LTC were 216.5 ± 39.3 lb and 36.1 ± 5.4 kg/m, respectively. Mean total body-weight loss (TBWL) at 12 and 24 months were 28.7% ± 9.5% and 28.4% ± 12.4%, respectively. The mean interval between the index bariatric surgery and LTC was 59.9 ± 34.9 months, mean operative time was 67 ± 18.2 min, and median length of stay (LOS) was 1 day (IQR = 1-2 days). Twelve patients (57.1%) were able to discontinue antisecretory medications, while 9 (42.9%) still required them to remain asymptomatic. Mortality and reoperation rates were 0% and the incidence of complication was 19.4% (n = 6).
LTC is a safe and effective surgical alternative to treat refractory GERD symptoms after SG.
肥胖是胃食管反流病（GERD）的已知危险因素。尽管袖状胃切除术（SG）引起的体重减轻可能会减轻或解决症状，但它可能与术后 GERD 的发生率较高有关。膈肌心包固定术（LTC）是治疗 GERD 的金标准治疗方法 Roux-en-Y 胃旁路术的替代方法。
本研究是一项回顾性单中心图表回顾研究，本队列中的所有患者在我院均接受 LTC 治疗难治性 GERD。在患者拒绝进行 RYGB 转换后，提出了进行 LTC 的选择。我们收集了基线特征、标准人口统计学、术前检查和影像学以及 SG 信息，以及 LTC 的术中及围手术期数据和术后并发症。
我们的队列包括 29 名患者；大多数是白人（44.8%）女性（86.2%）。LTC 前的平均体重和 BMI 分别为 216.5 ± 39.3 磅和 36.1 ± 5.4 kg/m。12 个月和 24 个月时的平均总体体重减轻（TBWL）分别为 28.7%±9.5%和 28.4%±12.4%。指数减肥手术后与 LTC 之间的平均间隔时间为 59.9 ± 34.9 个月，平均手术时间为 67 ± 18.2 分钟，中位住院时间（LOS）为 1 天（IQR = 1-2 天）。12 名患者（57.1%）能够停止抗分泌药物，而 9 名患者（42.9%）仍需要它们来保持无症状。死亡率和再手术率均为 0%，并发症发生率为 19.4%（n = 6）。
LTC 是治疗 SG 后难治性 GERD 症状的安全有效的手术替代方法。
