Sadary Abanoub S N, Mostafa Alaa Abbas Sabry, El-Shayeb Bassem Helmy, Makram Fady, Gerges Wadie Boshra
Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Gastrointest Surg. 2025 Aug;29(8):102098. doi: 10.1016/j.gassur.2025.102098. Epub 2025 May 28.
Most studies have described worsening or de novo development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG). Previous literature described a technique for managing GERD using the ligamentum teres hepatis as a sling around the esophagogastric junction, "ligamentum teres cardiopexy" (LTC). Recently, bariatric surgeons have proposed LTC for managing intrathoracic gastric migration and GERD after LSG. Few short-term studies with low numbers of patients have shown high rates of reflux resolution. This study was designed to retrospectively study the short-term outcome of LTC during LSG with hiatoplasty (HP) using objective assessment using manometry and endoscopy.
Patients with morbid obesity with GERD who underwent LSG with suture HP, with or without LTC, and completed the follow-up requirements (at least 12 months of follow-up followed by endoscopy and manometry) were included. After a minimum of 1 year, the following data were collected and compared: percentage of excess weight loss (%EWL), GERD symptoms using the Gastroesophageal Reflux Disease Questionnaire (GERD-Q) score, and findings of postoperative investigations (endoscopy and manometry).
Overall, 32 patients were included in group A (LSG + HP). The mean %EWL was 65%. The mean GERD-Q score improved from 12.3 ± 2.9 to 9.8 ± 2.7. The mean lower esophageal sphincter (LES) pressure increased from 10.8 ± 3.2 to 13.7 ± 2.6 mm Hg. In addition, 29 patients were included in group B (LSG + HP + LTC). The mean %EWL was 63.2%. The mean GERD-Q score improved from 11.8 ± 3.1 to 8.3 ± 2.3. The mean LES pressure increased from 10.2 ± 3.4 to 13.1 ± 2.7 mm Hg. In both groups, endoscopy showed significantly less patients having hiatal hernia (HH) and esophagitis. All postoperative clinical data showed significant and highly significant improvement. When comparing both groups, the only significant difference was the GERD-Q score, in which a lower mean level was observed in group B.
Posterior suture HP during LSG with or without LTC in patients with GERD resulted in significant improvement of GERD symptoms, LES pressure values, esophagitis, and HH detection after 1 year. Adding LTC further improved the GERD symptoms.
大多数研究描述了腹腔镜袖状胃切除术（LSG）后胃食管反流病（GERD）病情恶化或新发的情况。既往文献描述了一种使用肝圆韧带作为食管胃交界处吊带治疗GERD的技术，即“肝圆韧带贲门固定术”（LTC）。最近，减重外科医生提出采用LTC治疗LSG后的胸内胃移位和GERD。少数纳入患者数量较少的短期研究显示反流缓解率较高。本研究旨在通过测压和内镜客观评估，回顾性研究LSG联合裂孔成形术（HP）时行LTC的短期疗效。
纳入患有GERD的病态肥胖患者，这些患者接受了带缝合HP的LSG，无论是否行LTC，并完成了随访要求（至少12个月的随访，随后进行内镜检查和测压）。至少1年后，收集并比较以下数据：超重减轻百分比（%EWL）、使用胃食管反流病问卷（GERD-Q）评分的GERD症状，以及术后检查（内镜检查和测压）结果。
总体而言，A组（LSG + HP）纳入32例患者。平均%EWL为65%。GERD-Q评分均值从12.3±2.9改善至9.8±2.7。食管下括约肌（LES）平均压力从10.8±3.2升高至13.7±2.6 mmHg。此外，B组（LSG + HP + LTC）纳入29例患者。平均%EWL为63.2%。GERD-Q评分均值从11.8±3.1改善至8.3±2.3。LES平均压力从10.2±3.4升高至13.1±2.7 mmHg。两组内镜检查均显示发生食管裂孔疝（HH）和食管炎的患者明显减少。所有术后临床数据均显示有显著和高度显著改善。比较两组时，唯一显著差异在于GERD-Q评分，B组的平均水平较低。
GERD患者在LSG时行或不行LTC的后缝合HP，均可使GERD症状、LES压力值以及1年后食管炎和HH检出率得到显著改善。加用LTC可进一步改善GERD症状。
