Kollmann Lars, Thurner Annette, Miras Alexander Dimitri, Seyfried Florian
Head of Surgery for Upper Gastrointestinal Tract and Metabolic Surgery, Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany.
Department of Radiology, University Hospital Wuerzburg, Würzburg, Germany.
Updates Surg. 2024 Dec;76(8):2973-2976. doi: 10.1007/s13304-024-02017-9. Epub 2024 Oct 2.
Roux-en-Y gastric bypass (RYGB) is the preferred surgical option for patients with proven gastroesophageal reflux disease and obesity grade ≥ II (BMI ≥ 35 kg/m). Data on simultaneous treatment of larger hiatal hernias during RYGB are scarce. From 2012 until 2022, data from all consecutive patients undergoing gastric bypass procedures were collected and retrospectively analyzed. The characteristics and surgical outcomes of patients undergoing RYGB alone (RYGBa) versus RYGB with simultaneous treatment of a large hiatal hernia (RYGB-HH) were compared. Out of 573 patients who received RYGB, we identified 12 simultaneously treated for large hiatal hernia. The characteristics of RYGB-HH versus RYGBa patients were higher age (55 vs. 44 years; p = 0.004) and lower BMI (39.2 vs. 46.9 kg/m; p = 0.001). Duration of surgery in the RYGB-HH group was longer (144 min vs. 98 min; p < 0.001), while complications > Clavien-Dindo II were similar compared to the RYGBa group (8.3 vs. 9.4%, p = 0.56). Length of stay did not differ among the groups (4 vs. 5.5 days, p = 0.051). At a median follow-up of 12 months, there was no clinical recurrence of hiatal hernia in the RYGB-HH group. Simultaneous treatment of large hiatal hernias during Roux-en-Y gastric bypass surgery prolongs operation time but seems feasible and safe in the hands of experienced surgeons.
Roux-en-Y胃旁路术（RYGB）是确诊为胃食管反流病且肥胖程度≥II级（BMI≥35kg/m²）患者的首选手术方式。关于RYGB术中同时治疗较大食管裂孔疝的数据较少。2012年至2022年，收集了所有接受胃旁路手术的连续患者的数据并进行回顾性分析。比较了单纯接受RYGB（RYGBa）与同时治疗大食管裂孔疝的RYGB（RYGB-HH）患者的特征和手术结果。在接受RYGB的573例患者中，我们确定了12例同时接受大食管裂孔疝治疗的患者。RYGB-HH组与RYGBa组患者的特征比较显示，前者年龄更大（55岁对44岁；p=0.004），BMI更低（39.2kg/m²对46.9kg/m²；p=0.001）。RYGB-HH组的手术时间更长（144分钟对98分钟；p<0.001），而与RYGBa组相比，Clavien-Dindo II级以上并发症相似（8.3%对9.4%，p=0.56）。各组的住院时间无差异（4天对5.5天，p=0.051）。在中位随访12个月时，RYGB-HH组食管裂孔疝无临床复发。Roux-en-Y胃旁路手术中同时治疗大食管裂孔疝会延长手术时间，但在经验丰富的外科医生手中似乎是可行且安全的。
