Smith S C, Edwards C B, Goodman G N
Rocky Mountain Associated Physicians, Salt Lake City, Utah, USA.
Obes Surg. 1997 Dec;7(6):479-84. doi: 10.1381/096089297765555205.
Patients who suffer with gastroesophageal reflux Disease (GERD) endure a worsening of symptoms as their weight increases. When medical treatment of this condition in the morbidly obese patients fails, surgical intervention may be indicated. Choosing a procedure which not only helps achieve weight control but which also relieves symptoms and complications of GERD is the goal. We present a review of patients who have undergone Roux-en-Y Gastric Bypass (RYGBP) and related procedures for this disease.
One hundred eighty-eight patients undergoing surgery for morbid obesity and for GERD in 1992-1996 were contacted by mail or phone. All of these patients had undergone preoperative esophagogastroduodenoscopy to grade the severity of their disease. Their preoperative symptoms were compared to those experienced postoperatively.
One hundred thirty patients underwent a RYGBP with modified Hill fundopexy, 22 patients underwent a distal gastrectomy with modified Hill fundopexy, 8 patients underwent distal gastrectomy alone and 28 patients underwent RYGBP alone. There have been no deaths. There were nine surgical complications, eight early and one at 2.5 years postoperation. Follow-up is 4-48 months. The average BMI dropped from 43 to 30.2 kg/m2. Whereas all patients were on some form of medical therapy before surgery, only 14 reported the need for medication postoperatively.
Surgical intervention for weight control and treatment of GERD has been highly successful in our experience both with respect to weight control and to the reduction of reflux symptoms. Depending upon endoscopic and operative findings a RYGBP with or without an antireflux procedure can provide dramatic improvement. Gastrectomy with antireflux modifications is appropriate in selected cases.
胃食管反流病（GERD）患者的症状会随着体重增加而加重。当病态肥胖患者的这种疾病药物治疗失败时，可能需要手术干预。选择一种不仅有助于控制体重，还能缓解GERD症状和并发症的手术是目标。我们对接受 Roux-en-Y 胃旁路术（RYGBP）及相关手术治疗该病的患者进行了综述。
通过邮件或电话联系了1992年至1996年间因病态肥胖和GERD接受手术的188名患者。所有这些患者术前均接受了食管胃十二指肠镜检查以评估疾病的严重程度。将他们的术前症状与术后症状进行比较。
130例患者接受了RYGBP联合改良希尔胃底折叠术，22例患者接受了远端胃切除术联合改良希尔胃底折叠术，8例患者仅接受了远端胃切除术，28例患者仅接受了RYGBP。无死亡病例。有9例手术并发症，8例为早期并发症，1例在术后2.5年出现。随访时间为4至48个月。平均体重指数从43降至30.2kg/m²。术前所有患者均接受某种形式的药物治疗，术后只有14例报告需要药物治疗。
在我们的经验中，手术干预用于控制体重和治疗GERD在体重控制和减少反流症状方面都非常成功。根据内镜和手术结果，RYGBP联合或不联合抗反流手术均可带来显著改善。在某些特定病例中，行抗反流改良的胃切除术是合适的。
