Sleeve gastrectomy with anti-reflux procedures

Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors.

【研究目的】袖状胃切除术（Sleeve gastrectomy）是目前全球治疗肥胖症增速最快的外科术式，但该术式可能诱发或加重胃食管反流病（gastroesophageal reflux disease, GERD）。本文最初旨在探讨在常规袖状胃切除术基础上联合抗反流手术（包括食管周脂肪垫切除、食管裂孔疝修补、胃残端小褶叠缝合固定术）的术式，并报告其早远期疗效。
【方法】本研究纳入88例合并胃食管反流病症状的肥胖患者，均接受袖状胃切除术联合抗反流手术治疗，其中50例同期接受转运分隔术治疗。将上述患者的减重效果与既往接受常规袖状胃切除术的360例连续病例，以及接受袖状胃切除术联合转运分隔术的1140例患者进行对比。此外，对所有接受抗反流袖状胃切除术的患者均专项调研胃食管反流病症状，并将调研结果与50例行常规袖状胃切除术、60例行袖状胃切除术联合转运分隔术且术前均存在胃食管反流病症状的患者的问卷结果进行对比。
【结果】在减重效果方面，抗反流袖状胃切除术患者的体质量指数超额丢失百分比不劣于常规袖状胃切除术患者；而抗反流袖状胃切除术联合转运分隔术患者的减重效果也不劣于袖状胃切除术联合转运分隔术患者。抗反流袖状胃切除术未增加手术并发症发生率，且可显著缓解胃食管反流病症状，同时减少质子泵抑制剂（proton pump inhibitors, PPI）的使用需求。
【结论】在常规袖状胃切除术基础上联合食管裂孔疝修补、贲门褶叠固定等抗反流手术，既未增加手术并发症发生率，也未对减重效果产生不良影响，却可显著降低胃食管反流病症状的发生率，并减少质子泵抑制剂的使用量。