Zuercher H, Koussayer B, Wang C, Rachman B, Sands V, Sandhu M, McEwen C, Mhaskar R, DuCoin C, Mooney A
University of South Florida Morsani College of Medicine, University of South Florida, Tampa FL.
Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL.
Surg Pract Sci. 2023 Jul 1;14:100197. doi: 10.1016/j.sipas.2023.100197. eCollection 2023 Sep.
Hiatal hernia (HH) is routinely reported in 40% of bariatric surgery patients. Left unrepaired, HH can lead to post-surgical reflux, regurgitation, and vomiting.
We hypothesize that patients with pre-operative reflux symptoms and a higher body mass index (BMI) will receive hiatal hernia repairs (HHR) more often. The study aim was to analyze the variables that drive HHR decision by operating surgeons.
The records of 551 patients who underwent endoscopy in preparation for bariatric surgery were analyzed. Prevalence of HH was derived based on esophagogastroduodenoscopy (EGD) findings performed by a bariatric surgeon during patients' bariatric surgery. The relationship between categorical participant attributes was calculated using a significance level of 0.05.
The groups consisted of 295 Roux-en-Y gastric bypass (RYGB) and 264 sleeve gastrectomy (SG) patients with preoperative HH identified in 310 patients. SG and a decreased BMI were significant for receiving a HHR. Type II diabetes (T2D), duodenitis found on EGD and pathology report, esophagitis, and Roux-en-Y gastric bypass (RYGB) were significant for not receiving a HHR. Only duodenitis, RYGB, and SG were found to be significant factors after multivariate analysis.
While some pre-operative patient characteristics may not impact a surgeon's HHR decision in the bariatric population, our study suggests that duodenitis, SG, and RYGB may influence a surgeon's HHR decision.
在40%的减肥手术患者中，常报告有食管裂孔疝（HH）。若不修复，食管裂孔疝可导致术后反流、反胃和呕吐。
我们假设术前有反流症状且体重指数（BMI）较高的患者更常接受食管裂孔疝修补术（HHR）。本研究的目的是分析促使手术医生做出食管裂孔疝修补术决策的变量。
分析了551例为准备减肥手术而接受内镜检查的患者的记录。食管裂孔疝的患病率是根据减肥外科医生在患者减肥手术期间进行的食管胃十二指肠镜检查（EGD）结果得出的。使用0.05的显著性水平计算分类参与者属性之间的关系。
这些组包括295例行Roux-en-Y胃旁路术（RYGB）的患者和264例行袖状胃切除术（SG）的患者，其中310例患者术前被诊断出有食管裂孔疝。接受食管裂孔疝修补术与袖状胃切除术和体重指数降低显著相关。2型糖尿病（T2D）、EGD和病理报告中发现的十二指肠炎、食管炎以及Roux-en-Y胃旁路术（RYGB）与未接受食管裂孔疝修补术显著相关。多因素分析后发现，只有十二指肠炎、RYGB和SG是显著因素。
虽然一些术前患者特征可能不会影响减肥人群中外科医生的食管裂孔疝修补术决策，但我们的研究表明，十二指肠炎、SG和RYGB可能会影响外科医生的食管裂孔疝修补术决策。
