Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia

被引:180
作者
Soricelli, Emanuele [1 ]
Iossa, Angelo [1 ]
Casella, Giovanni [1 ]
Abbatini, Francesca [1 ]
Cali, Benedetto [1 ]
Basso, Nicola [1 ]
机构
[1] Univ Roma La Sapienza, Surg Med Dept Digest Dis, Policlin Umberto I, I-00161 Rome, Italy
关键词
Sleeve gastrectomy; Gastroesophageal reflux disease; Hiatal hernia; Crural repair; Y GASTRIC BYPASS; BODY-MASS INDEX; MORBIDLY OBESE; NISSEN FUNDOPLICATION; WEIGHT-LOSS; RISK; EXPERIENCE; MANAGEMENT; DISORDERS; PRESSURE;
D O I
10.1016/j.soard.2012.06.003
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Gastroesophageal reflux disease (GERD) with or without hiatal hernia (HH) is now recognized as an obesity-related co-morbidity. Roux-en-Y gastric bypass has been proved to be the most effective bariatric procedure for the treatment of morbidly obese patients with GERD and/or HH. In contrast, the indication for laparoscopic sleeve gastrectomy (SG) in these patients is still debated. Our objective was to report our experience with 97 patients who underwent SG and HH repair (HHR). The setting was a university hospital in Italy. Methods: From July 2009 to December 2011, 378 patients underwent a preoperative workup for SG. In 97 patients, SG was performed with HHR. The clinical outcome was evaluated considering GERD symptom resolution or improvement, interruption of antireflux medications, and radiographic evidence of HH recurrence. Results: Before surgery, symptomatic GERD was present in 60 patients (15.8%), and HH was diagnosed in 42 patients (11.1%). In 55 patients (14.5%), HH was diagnosed intraoperatively. The mean follow-up was 18 months. GERD remission occurred in 44 patients (73.3%). In the remaining 16 patients, antireflux medications were diminished, with complete control of symptoms in 5 patients. No HH recurrences developed. "De novo" GERD symptoms developed in 22.9% of the patients undergoing SG alone compared with 0% of patients undergoing SG plus HHR. Conclusion: SG with HHR is feasible and safe, providing good management of GERD in obese patients with reflux symptoms. Small hiatal defects could be underdiagnosed at preoperative endoscopy and/or upper gastrointestinal contrast study. Thus, a careful examination of the crura is always recommended intraoperatively. (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.
引用
收藏
页码:356 / 361
页数:6
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