Department of Clinical Research Management, The University of North Texas Health and Science Center, Fort Worth, TX, United States.
Department of Surgery, Center for Advanced Surgery, Baylor Scott & White Health, Dallas, TX, United States; Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, United States; Department of Surgery, Texas A&M School of Medicine, College Station, TX, United States.
J Gastrointest Surg. 2024 Oct;28(10):1682-1686. doi: 10.1016/j.gassur.2024.07.016. Epub 2024 Aug 15.
Obesity affects more than one-third of Americans and can be treated with bariatric surgery, most commonly sleeve gastrectomy (SG). SG has been shown to increase the incidence of gastroesophageal reflux disease (GERD) in some patients, which can be refractory to medical management. Surgical options for post-SG GERD include magnetic sphincter augmentation (MSA) and subtotal gastrectomy with Roux-en-Y reconstruction (SGRY). A comparative analysis of MSA and SGRY for post-SG GERD was performed to evaluate postoperative outcomes.
A retrospectively maintained prospectively gathered database from 2018 to 2023 was used to identify patients who underwent MSA or SGRY for the indication of GERD after SG. Differences among patient characteristics; GERD assessments, including the health-related quality of life (HRQL) questionnaire and the reflux symptom index (RSI); and procedure outcomes were collected and analyzed according to surgery type.
A total of 92 patients (85 females and 7 males) met the inclusion criteria. The study included 17 patients in the MSA group, 71 patients in the SGRY group, and 4 patients who underwent both procedures. The average preoperative body mass index (BMI) of all patients was 33.3. Compared with patients who underwent MSA, those who underwent SGRY presented with higher BMI (29.4 vs 34.2, respectively; P = .013), preoperative GERD-HRQL (35 vs 52, respectively; P = .046), and RSI (14 vs 28, respectively; P = .017). Postoperatively, patients who underwent SGRY demonstrated a higher decrease in mean postoperative DeMeester score than those who underwent MSA (44.2 vs 13.9, respectively; P = .040), with 22 patients (50%) in the SGRY group vs 10 patients (20%) in the MSA group achieving normalization.
Although MSA remains a viable surgical alternative, our study indicated that SGRY can produce better symptom control and decrease acid exposure compared with MSA in patients with post-SG GERD.
肥胖影响超过三分之一的美国人，可以通过减重手术治疗，最常见的是袖状胃切除术（SG）。一些患者的研究表明，SG 会增加胃食管反流病（GERD）的发病率，而这种疾病可能对药物治疗有抵抗力。SG 后治疗 GERD 的手术选择包括磁括约肌增强（MSA）和 Roux-en-Y 重建的胃大部切除术（SGRY）。对 SG 后 MSA 和 SGRY 治疗 GERD 进行了比较分析，以评估术后结果。
使用 2018 年至 2023 年期间维护的前瞻性收集的数据库，确定了因 SG 后 GERD 而行 MSA 或 SGRY 的患者。根据手术类型收集和分析患者特征、GERD 评估（包括健康相关生活质量问卷和反流症状指数）和手术结果之间的差异。
共有 92 名患者（85 名女性和 7 名男性）符合纳入标准。该研究包括 MSA 组 17 例，SGRY 组 71 例，以及 4 例同时接受两种手术的患者。所有患者的平均术前体重指数（BMI）为 33.3。与接受 MSA 的患者相比，接受 SGRY 的患者 BMI 更高（分别为 29.4 和 34.2，P=0.013），术前 GERD-HRQL 评分更高（分别为 35 和 52，P=0.046），RSI 评分更高（分别为 14 和 28，P=0.017）。术后，SGRY 组患者的平均术后 DeMeester 评分下降幅度高于 MSA 组（分别为 44.2 和 13.9，P=0.040），SGRY 组 22 例（50%）患者达到正常，而 MSA 组仅 10 例（20%）患者达到正常。
尽管 MSA 仍然是一种可行的手术选择，但我们的研究表明，在 SG 后 GERD 患者中，与 MSA 相比，SGRY 可以更好地控制症状并减少胃酸暴露。
