Meyer Daniel, Mocanu Valentin, Switzer Noah J, Birch Daniel W, Karmali Shahzeer
Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB T5H 3V9, Canada.
Department of Surgery, University of Alberta, Edmonton, AB T6G 2N1, Canada.
J Clin Med. 2024 Oct 14;13(20):6117. doi: 10.3390/jcm13206117.
The use of a single anastomosis duodeno-ileal bypass (SADI) as a revisional procedure in patients with pre-operative GERD is not well understood. Thirty-day outcomes in patients with pre-existing GERD undergoing revision with an SADI have not been previously reported. The Metabolic and Bariatric Accreditation and Quality Improvement Program registry was consulted to identify patients undergoing revisional bariatric surgery with an SADI between 2020 and 2021. Our analysis sought to determine if preoperative GERD had significant impact on thirty-day outcomes. Bivariate and multivariable logistic regression analyses were used to identify independent predictors of 30-day morbidity. Preoperative GERD was seen in 342 patients (36.7%). Preoperative GERD was not associated with anastomotic leak (2.5% non-GERD cohort vs. 1.2% GERD cohort; = 0.2) nor bleeding (1% non-GERD cohort vs. 1.8% GERD cohort; = 0.33). There was no difference in thirty-day readmission (5.6% vs. 5.9%, = 0.9), reintervention (2.4% vs. 1.2%, = 0.2), or reoperation (3.6% vs. 2.05%; = 0.19) rates. The multivariable regression analysis revealed that a history of myocardial infarction was associated with a significantly elevated risk of serious complication (OR 12.2; 95% CI 2.79-53.23; = 0.001), as was dyslipidemia (OR 2.2; 95% CI 1.04-4.56; = 0.04). Pre-operative GERD does not have any association with anastomotic leak, bleeding, thirty-day readmission, reintervention, or reoperation in patients undergoing revisional bariatric surgery to SADI. A history of myocardial infarction and dyslipidemia are independent predictors of post-operative thirty-day morbidity, irrespective of the presence of preoperative GERD.
在术前患有胃食管反流病（GERD）的患者中，使用单吻合十二指肠-回肠旁路术（SADI）作为修正手术的情况尚未得到充分了解。既往未曾报道过接受SADI修正手术的GERD患者的30天结局。我们查阅了代谢与减重认证及质量改进项目登记册，以确定2020年至2021年间接受SADI修正减重手术的患者。我们的分析旨在确定术前GERD是否对30天结局有显著影响。采用双变量和多变量逻辑回归分析来确定30天发病率的独立预测因素。342例患者（36.7%）存在术前GERD。术前GERD与吻合口漏（非GERD队列2.5% vs. GERD队列1.2%；P = 0.2）或出血（非GERD队列1% vs. GERD队列1.8%；P = 0.33）均无关联。30天再入院率（5.6% vs. 5.9%，P = 0.9）、再次干预率（2.4% vs. 1.2%，P = 0.2）或再次手术率（3.6% vs. 2.05%；P = 0.19）无差异。多变量回归分析显示，心肌梗死病史与严重并发症风险显著升高相关（比值比12.2；95%置信区间2.79 - 53.23；P = 0.001），血脂异常也是如此（比值比2.2；95%置信区间1.04 - 4.56；P = 0.04）。对于接受SADI修正减重手术的患者，术前GERD与吻合口漏、出血、30天再入院、再次干预或再次手术均无关联。心肌梗死病史和血脂异常是术后30天发病率的独立预测因素，与术前GERD的存在与否无关。
