Ani Firdaus Che, Loo Guo Hou, Chua Richelle Huey Bing, Chin Kok-Yong, Kosai Nik Ritza
Department of Surgery, Faculty of Medicine, University Technology MARA, Kuala Lumpur, Malaysia.
Upper Gastrointestinal & Metabolic Unit, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Langenbecks Arch Surg. 2025 Aug 13;410(1):243. doi: 10.1007/s00423-025-03827-0.
Laparoscopic sleeve gastrectomy (LSG) is effective for weight loss but may exacerbate gastroesophageal reflux disease (GERD) in predisposed patients. This randomized controlled trial aimed to evaluate whether adding cruroplasty to LSG (Cr-LSG) improves postoperative GERD symptom control in patients with intraoperative evidence of hiatal laxity.
A total of 100 patients undergoing LSG were randomized to either standard LSG or LSG with posterior cruroplasty (Cr-LSG). Patients with large hiatal hernias were excluded. GERD symptoms were assessed using the validated GERD-Health Related Quality of Life (GERD-HRQL) questionnaire at baseline, 3 months, and 6 months postoperatively. BMI changes were also recorded. Statistical analysis included mixed-design ANOVA for within- and between-group comparisons.
Of the 100 enrolled patients, 95 (95%) completed the 6-month follow-up (LSG: 47, Cr-LSG: 48). Both groups demonstrated significant BMI reductions over time, with no between-group differences. GERD symptoms improved significantly within both groups postoperatively. However, between-group comparisons showed significantly lower GERD-HRQL scores in the Cr-LSG group at both 3 and 6 months (p < 0.05), suggesting better symptom control. Postoperative PPI use was not systematically recorded and represents a limitation.
Adding cruroplasty to LSG may enhance short-term reflux symptom control in selected patients with intraoperative hiatal laxity. However, given the study's reliance on subjective symptom reporting and limited follow-up, these findings should be interpreted with caution. Further studies using objective diagnostics and longer-term follow-up are warranted.
腹腔镜袖状胃切除术（LSG）对减重有效，但可能会使易感患者的胃食管反流病（GERD）加重。这项随机对照试验旨在评估在LSG基础上加做膈肌成形术（Cr-LSG）是否能改善术中存在食管裂孔松弛证据的患者术后GERD症状的控制情况。
总共100例行LSG的患者被随机分为标准LSG组或加做后外侧膈肌成形术的LSG组（Cr-LSG组）。排除有大型食管裂孔疝的患者。在基线、术后3个月和6个月时，使用经过验证的GERD健康相关生活质量（GERD-HRQL）问卷评估GERD症状。同时记录体重指数（BMI）的变化。统计分析包括用于组内和组间比较的混合设计方差分析。
100名入组患者中，95名（95%）完成了6个月的随访（LSG组：47名，Cr-LSG组：48名）。两组患者的BMI均随时间显著降低，组间无差异。两组患者术后GERD症状均显著改善。然而，组间比较显示，Cr-LSG组在术后3个月和6个月时的GERD-HRQL评分均显著更低（p<0.05），表明症状控制更好。术后质子泵抑制剂（PPI）的使用未进行系统记录，这是一个局限性。
在LSG基础上加做膈肌成形术可能会增强术中存在食管裂孔松弛的特定患者的短期反流症状控制。然而，鉴于该研究依赖主观症状报告且随访有限，这些发现应谨慎解读。有必要进行使用客观诊断方法和长期随访的进一步研究。
