Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence

被引:33
作者
Ruscio, Sara [1 ]
Abdelgawad, Mohamed [1 ,2 ]
Badiali, Danilo [3 ]
Iorio, Olga [1 ]
Rizzello, Mario [1 ]
Cavallaro, Giuseppe [1 ]
Severi, Carola [3 ]
Silecchia, Gianfranco [1 ]
机构
[1] Univ Roma La Sapienza, Div Gen Surg, Dept Medicosurg Sci & Biotechnol, Bariatr Ctr Excellence IFSO EU, Via F Faggiana 1668, I-04100 Latina, Italy
[2] Mansoura Univ, Fac Med, Gastroenterol Surg Ctr, Mansoura, Egypt
[3] Univ Roma La Sapienza, Dept Internal Med & Med Disciplines, Viale Policlin 155, I-00161 Rome, Italy
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2016年 / 30卷 / 06期
关键词
Cruroplasty; Bio-A absorbable mesh; Sleeve gastrectomy; Morbid obesity; Hiatal hernia; GERD; GASTROESOPHAGEAL-REFLUX DISEASE; PARAESOPHAGEAL HERNIA REPAIR; NISSEN FUNDOPLICATION; ABSORBABLE MESH; HIATUS-HERNIA; CLASSIFICATION; OBESE; GUIDELINES; OUTCOMES;
D O I
10.1007/s00464-015-4487-0
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Crural closure in addition to laparoscopic sleeve gastrectomy (LSG) represents a valuable option for the synchronous management of morbid obesity and hiatal defects, providing good outcomes in terms of weight loss and gastroesophageal reflux disease (GERD) symptoms control. The aim of this prospective study was to evaluate the safety and effectiveness of the reinforced cruroplasty during LSG compared with a concurrent group of simple cruroplasty. Methods The study groups included 96 morbidly obese patients who underwent simultaneous LSG and cruroplasty. Group A: 48 patients with hiatal areal defect <4 cm 2 and normal pillars (simple posterior cruroplasty); group B: 48 patients with hiatal areal defect >4 and < 8 cm 2 with weakness of the right pillar (on-lay synthetic absorbable mesh-reinforced cruroplasty). Upper GI symptoms were assessed by Roma III standard questionnaire. Endoscopy, imaging, esophageal 24-h pH monitoring and HRmanometry were performed in cases of persistent or recurrent symptoms after surgery. Results Mortality rate was nil. The conversion rate to open was 1 %. Intra-operative diagnosis of hiatal hernia occured in 41 patients (42.7 %). Mesh-related complications were none. Perioperative complications occurred in four patients (4.1 %). After 19-to 21-month follow-up, GERD symptom remission occurred in 89 % of patients. GERD symptoms were detected postoperatively in eight patients: six in group A (five symptomatic and radiological recurrences and one persistent) and two in group B (one persistent and one de novo GERD) (P < 0.05). Conclusions The synthetic absorbable mesh offers an effective option for crural repair during LSG with no clinical recurrences at 19 months. The midterm results of this prospective comparative study evaluating two different technical options for cruroplasty confirm that the simultaneous procedures are safe and cruroplasty is effective in mild-to-moderate GERD control.
引用
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页码:2374 / 2381
页数:8
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