Cao Ke, Zhai Zhiwei, Shi Xuyin, Jin Yin, Ye Chunxiang, Wu Yunlong, Sun Mingyu, Wang Jing, Wang Zhenjun, Han Jiagang
Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, No. 8 Gongtinan Lu, Chaoyang District, Beijing, 100020, China.
BMC Gastroenterol. 2025 Aug 21;25(1):611. doi: 10.1186/s12876-025-04216-z.
While laparoscopic sleeve gastrectomy (LSG) is an established bariatric procedure for obesity, postoperative gastroesophageal reflux disease (GERD) remains a significant complication. This study evaluates the short-term efficacy of a novel technique combining LSG with acute angle of His reconstruction (LSG-His) versus conventional LSG.
This is a single center retrospective observation cohort study. Among 83 patients undergoing bariatric surgery, 39 receiving conventional LSG and 44 undergoing LSG-His (with diaphragmatic fundopexy using 2-0 Prolene sutures) were analyzed. GERD symptoms were assessed using the Reflux Diagnostic Questionnaire (RD-Q) and GERD Questionnaire (GERD-Q) at baseline and at 3-, 6-, 12-, 24-month postoperatively. Weight loss outcomes included percentage of excess weight loss (%EWL) and total weight loss.
Postoperative follow-up showed a sustained reduction in GERD symptoms for the LSG-His group across all time points using both scoring systems (all p<0.001 vs LSG). The results demonstrated that, when assessed using the GERD-Q at the 24-month follow-up, the prevalence of GERD symptoms was 14% (95% CI: 6.3% - 25.7%) among LSG-His patients versus 46% (95% CI: 32.1% - 60.7%) among LSG patients (p<0.001). As evaluated via the RD-Q at the same 24-month follow-up, GERD symptom prevalence was 7% (95% CI: 2.3%- 17.9%) in the LSG-His group compared with 41% (95% CI: 27.3% - 56.3%) in the LSG group (p<0.001).%EWL was higher in the LSG-His group at 3 months (54.7% vs 46.5%, p=0.033), 6 months (73.8% vs 64%, p=0.047), 12 months (82.9% vs 72.2%, p=0.042) and 24 months (84.1% vs 75.4%, p=0.038) follow-up compared to LSG group.
In this retrospective observational study, LSG-His was associated with lower rates of GERD symptoms and higher %EWL compared to standard LSG, but with comparable %TWL in 24 month outcomes. However, these preliminary results are limited to short-term follow-up, and long-term prospective studies with objective reflux assessment are warranted.
虽然腹腔镜袖状胃切除术（LSG）是一种成熟的治疗肥胖症的减肥手术，但术后胃食管反流病（GERD）仍然是一个严重的并发症。本研究评估了一种将LSG与His角重建（LSG-His）相结合的新技术与传统LSG相比的短期疗效。
这是一项单中心回顾性观察队列研究。在83例接受减肥手术的患者中，分析了39例接受传统LSG的患者和44例接受LSG-His（使用2-0普理灵缝线进行膈肌固定术）的患者。在基线以及术后3、6、12、24个月时，使用反流诊断问卷（RD-Q）和GERD问卷（GERD-Q）评估GERD症状。体重减轻结果包括超重减轻百分比（%EWL）和总体重减轻。
术后随访显示，使用两种评分系统，LSG-His组在所有时间点的GERD症状均持续减轻（与LSG组相比，所有p<0.001）。结果表明，在24个月随访时使用GERD-Q评估，LSG-His组患者中GERD症状的患病率为14%（95%CI：6.3%-25.7%），而LSG组为46%（95%CI：32.1%-60.7%）（p<0.001）。在相同的24个月随访时通过RD-Q评估，LSG-His组的GERD症状患病率为7%（95%CI：2.3%-17.9%），而LSG组为41%（95%CI：27.3%-56.3%）（p<0.001）。与LSG组相比，LSG-His组在3个月（54.7%对46.5%，p=0.033）、6个月（73.8%对64%，p=0.047））、12个月（82.9%对72.2%，p=0.042）和24个月（84.1%对75.4%，p=0.038）随访时的%EWL更高。
在这项回顾性观察研究中，与标准LSG相比，LSG-His与较低的GERD症状发生率和较高的%EWL相关，但在24个月的结果中%TWL相当。然而，这些初步结果仅限于短期随访，需要进行具有客观反流评估的长期前瞻性研究。
