腹腔镜垂直袖状胃切除术和腹腔镜 Roux-en-Y 胃旁路术对胃食管反流病的影响：一项来自随机对照试验的 5 年术后数据的更新荟萃分析和系统评价。
The effect of laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass on gastroesophageal reflux disease: An updated meta-analysis and systematic review of 5-year post-operative data from randomized controlled trials.
机构信息
School of Mathematics, Physics and Computing and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, Australia.
Sunnybank Obesity Centre & South East Queensland Surgery (SEQS), Sunnybank, QLD, Australia.
出版信息
Surg Endosc. 2024 Nov;38(11):6254-6269. doi: 10.1007/s00464-024-11303-x. Epub 2024 Oct 9.
BACKGROUND
To evaluate 5-year effect of laparoscopic vertical sleeve gastrectomy (LVSG) versus laparoscopic roux-en-Y gastric bypass (LRYGB) on gastroesophageal reflux disease (GERD) solely based on randomized controlled trials (RCTs).
METHODS
A systematic review and meta-analysis of 5-year postoperative GERD data comparing LVSG and LRYGB in adults were undertaken. Electronic databases were searched from January 2015 to March 2024 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was applied to estimate pooled odds ratio where meta-analysis was possible. Bias and certainty of evidence were assessed using the Cochrane Risk of Bias Tool 2 and GRADE.
RESULTS
Five RCTs were analysed (LVSG n = 554, LRYGB n = 539). LVSG was associated with increased adverse GERD outcomes compared to LRYGB at 5 years. The odds for revisional surgery to treat GERD in LVSG patients were 11 times higher compared to LRYGB (OR 11.47, 95% CI 1.83 to 71.69; p = 0.02; I = 0% High level of certainty). Similarly pharmacological management for increasing GERD was significantly more frequent in LVSG patients compared to LRYGB (OR 3.89, 95% CI 2.31 to 6.55; p ≤ 0.01; I = 0% Moderate level of certainty). Overall, LVSG was associated with significantly more interventions (both medical and surgical) for either worsening GERD and/or development of de novo GERD compared to LRYGB (OR 5.98, 95% CI 3.48 to 10.29; p ≤ 0.01; I = 0%) Moderate level of certainty).
CONCLUSIONS
The development and worsening of GERD symptoms are frequently associated with LVSG compared to LRYGB at 5 years postoperatively requiring either initiation or increase of pharmacotherapy or failing that revisional bariatric surgery. Appropriate patient/surgical selection is crucial to reduce these postoperative risks of GERD.
背景
本研究旨在通过系统评价和荟萃分析，仅基于随机对照试验（RCT）评估腹腔镜垂直袖状胃切除术（LVSG）与腹腔镜 Roux-en-Y 胃旁路术（LRYGB）对胃食管反流病（GERD）的 5 年疗效。
方法
对符合纳入标准的成年人 LVSG 和 LRYGB 术后 5 年 GERD 数据的 RCT 进行系统评价和荟萃分析。从 2015 年 1 月至 2024 年 3 月，电子数据库检索符合纳入标准的文献。当可以进行荟萃分析时，采用哈顿-纳普-西迪克-容克曼随机效应模型来估计汇总比值比。采用 Cochrane 偏倚风险工具 2 和 GRADE 评估偏倚和证据确定性。
结果
共分析了 5 项 RCT（LVSG 组 n=554，LRYGB 组 n=539）。与 LRYGB 相比，LVSG 术后 5 年时 GERD 不良结局的风险增加。与 LRYGB 相比，LVSG 患者因 GERD 接受翻修手术的可能性要高 11 倍（OR 11.47，95%CI 1.83 至 71.69；p=0.02；I=0%高度确定性）。同样，与 LRYGB 相比，LVSG 患者因 GERD 而增加药物治疗的可能性也显著更高（OR 3.89，95%CI 2.31 至 6.55；p≤0.01；I=0%中度确定性）。总体而言，与 LRYGB 相比，LVSG 术后因 GERD 恶化或新发 GERD 而接受治疗（包括药物和手术治疗）的可能性显著更高（OR 5.98，95%CI 3.48 至 10.29；p≤0.01；I=0%中度确定性）。
结论
与 LRYGB 相比，LVSG 术后 5 年时 GERD 症状的发展和恶化更为常见，需要开始或增加药物治疗，否则需要进行翻修减重手术。选择合适的患者/手术至关重要，可以降低术后 GERD 的这些风险。
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