Umana Luke, Corsello Jenalee, Grist Thomas, Gonzalvo John Paul, Dietrick John, Murr Michel M
Bariatric & Metabolic Institute, AdventHealth Tampa, Tampa, Florida.
Bariatric & Metabolic Institute, AdventHealth Tampa, Tampa, Florida.
Surg Obes Relat Dis. 2025 Mar;21(3):256-262. doi: 10.1016/j.soard.2024.09.014. Epub 2024 Oct 9.
Symptoms of reflux after sleeve gastrectomy (SG) are common and may be refractory to medical treatment.
To assess outcomes of conversion of SG to Roux-en-Y gastric bypass (RYGB) with concomitant repair of hiatal hernias on symptoms of reflux.
Tertiary community hospital.
We reviewed data from all consecutive patients (2018-2021) who underwent conversion from SG to RYGB for refractory reflux symptoms. Concomitant hiatal hernias were diagnosed endoscopically or radiographically. Improvement in reflux symptoms, nausea, vomiting, dysphagia, or abdominal pain and postoperative proton pump inhibitor (PPI) use were compared with McNemar statistical test. Data are reported as mean ± standard deviation.
In total, 64 patients (92% female; 48 ± 10 years) underwent conversion from SG to RYGB and repair of concomitant hiatal hernias 4 ± 3 years after the index SG. A hiatal hernia was detected preoperatively in 57 of 64 patients (89%) by either upper gastrointestinal contrast studies, computed tomography scan, or esophagogastroduodenoscopy. At 29 ± 14 months postconversion to RYGB, percent total body weight loss was 14 ± 9% and percent excess weight loss was 37 ± 29%, and body mass index decreased from 37 ± 7 to 32 ± 6 kg/m. Symptoms of reflux and use of PPI improved during the early follow-up period (median: 14 months; P < .001) and was sustained at late follow-up (median: 32 months; P < .01). Improvement of nausea and dysphagia reached statistical significance at late follow-up (median: 32 months; P < .01). Vomiting and abdominal pain decreased with time but did not reach statistical significance. Postoperative complications were deep surgical-site infection (n = 3), pulmonary embolism (n = 1), bleeding (n = 5), reoperation (n = 3), and 30-day readmission (n = 6).
Conversion of SG to RYGB and repair of concomitant hiatal hernia improves reflux symptoms, nausea, and dysphagia, reduces PPI use, and confers additional weight loss.
袖状胃切除术（SG）后反流症状常见，且可能对药物治疗无效。
评估将SG转换为Roux-en-Y胃旁路术（RYGB）并同时修复食管裂孔疝对反流症状的影响。
三级社区医院。
我们回顾了所有连续患者（2018 - 2021年）的数据，这些患者因难治性反流症状从SG转换为RYGB。通过内镜或影像学检查诊断是否合并食管裂孔疝。采用McNemar统计检验比较反流症状、恶心、呕吐、吞咽困难或腹痛的改善情况以及术后质子泵抑制剂（PPI）的使用情况。数据以均值±标准差表示。
共有64例患者（92%为女性；年龄48±10岁）在初次SG术后4±3年从SG转换为RYGB并修复合并的食管裂孔疝。64例患者中有57例（89%）术前通过上消化道造影、计算机断层扫描或食管胃十二指肠镜检查发现食管裂孔疝。转换为RYGB后29±14个月，总体重减轻百分比为14±9%，超重体重减轻百分比为37±29%，体重指数从37±7降至32±6 kg/m²。反流症状和PPI的使用在早期随访期间（中位数：14个月；P <.001）有所改善，并在晚期随访（中位数：32个月；P <.01）时持续改善。恶心和吞咽困难的改善在晚期随访时达到统计学意义（中位数：32个月；P <.01）。呕吐和腹痛随时间减少，但未达到统计学意义。术后并发症包括深部手术部位感染（n = 3）、肺栓塞（n = 1）、出血（n = 5）、再次手术（n = 3）和30天再入院（n = 6）。
将SG转换为RYGB并修复合并的食管裂孔疝可改善反流症状、恶心和吞咽困难，减少PPI的使用，并带来额外的体重减轻。
