Mid-term efficacy analysis of laparoscopic sleeve gastrectomy or combined with hiatal hernia repair in the treatment of obesity with gastroesophageal reflux disease

doi:10.3877/cma.j.issn.1674-392X.2024.05.005

Abstract

Abstract:

Objective

To explore the clinical efficacy of laparoscopic sleeve gastrectomy(LSG)or combined with hiatal hernia repair (HHR) in the treatment of obesity with gastroesophageal reflux disease (GERD).

Methods

A retrospective analysis was performed on 45 obese patients with GERD who admitted to People's Hospital of Xinjiang Uygur Autonomous Region from January 2020 to April 2021 and completed the follow-up. Patients were divided into LSG combined with HHR group or LSG alone group according to the surgical method, and weight loss effects and improvement of comorbidities between two groups of patients were compared and analyzed.

Results

Among the 51 obese patients, six patients were lost to follow-up, and preoperative and postoperative data were obtained for the remaining 45 patients, the median follow-up time was 35 (28-43) months. Among the 45 patients, 16 patients were found to have hiatal hernia through preoperative examination and intraoperative exploration, and underwent LSG+HHR,while the remaining 29 patients underwent LSG. (1) There was no significant difference in the preoperative general information between two groups (P＞0.05). (2) The comparison of intraoperative and postoperative conditions between two groups showed that the LSG combined with HHR had a longer surgical time than the LSG group, and there was a significant difference (Z=-5.39, P＜0.001). There was no significant difference in the volume of intraoperative blood loss, postoperative hospital stays, readmission within 30 days after surgery, and incidence of gallbladder stones between two groups (P＞0.05). (3) The body mass index, %EWL and %TWL among the two groups did not meeting the mauchly's test of sphericity(χ²=62.53, 26.26, 29.45, P＜0.001). The results of multi-variate test showed that there was a significant difference in the time effect of the above indexes (F_time=274.5, 12.56, 11.75, P_time＜0.001), while there was no significant difference in intergroup and interaction effects [(F_intergroup=2.17, P_intergroup=0.15; F_interaction=0.64,P_interaction=0.55); (F_intergroup=1.28, P_intergroup=0.26; F_interaction=1.11, P_interaction=0.35); (F_intergroup=0.006, P_intergroup=0.94;F_interaction=0.99, P_interaction=0.40)]. (4) The Gastroesophageal reflux disease questionnaire(Gerd Q) score of patients in the LSG combined with HHR group decreased from 9 (8, 12) points before surgery to 7 (6, 11)points after surgery, and there was a significant difference (P＜0.05). The Gerd Q score of patients in the LSG group decreased from 9 (8, 11) points to 8 (6, 15) points, with no statistically significant difference(P=0.186).

Conclusion

LSG combined with HHR and LSG alone can significantly reduce body mass index in obese patients and effectively improve obesity related comorbidities. LSG combined with HHR can significantly improve GERD symptoms in obese patients, but there is no significant change in GERD symptoms after LSG.

Key words: Obesity, Gastroesophageal reflux disease(GERD), Hernia, hiatal, Hernia repair, Laparoscope, Sleeve gastrectomy

Qi Han, Maimaitiming Maimaitiaili, Xudong Huang, Hao Wang, Abudureyimu Kelimu, Aili Aikebaier. Mid-term efficacy analysis of laparoscopic sleeve gastrectomy or combined with hiatal hernia repair in the treatment of obesity with gastroesophageal reflux disease[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 501-506.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2024.05.005

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2024/V18/I05/501

Figures/Tables 3

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	术前合并症(例)
组别	例数	男性	女性	年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	高血压	糖尿病	糖尿病前期
LSG组	29	13(44.8)	16(55.2)	38±9	40.04±3.63	10	9	8
LSG联合HHR组	16	4(25.0)	12(75.0)	36±8	38.13±3.64	5	5	2
t/χ²值		1.73		0.92	1.69	0.04	0.00	1.36
P值		0.189		0.362	0.098	0.840	0.998	0.244

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	术前合并症(例)
组别	例数	男性	女性	年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	高血压	糖尿病	糖尿病前期
LSG组	29	13(44.8)	16(55.2)	38±9	40.04±3.63	10	9	8
LSG联合HHR组	16	4(25.0)	12(75.0)	36±8	38.13±3.64	5	5	2
t/χ²值		1.73		0.92	1.69	0.04	0.00	1.36
P值		0.189		0.362	0.098	0.840	0.998	0.244

组别	例数	手术时间[min,M(范围)]	术中出血量[ml,M(范围)]	术后住院时间[d,M(范围)]	术后30d内再入院(例)
LSG组	29	105(90,125)	80(50,150)	6(4,11)	1
LSG联合HHR组	16	130(115,140)	95(50,175)	6(4,8)	0
Z/Fisher值		-5.39	-0.68	-0.69	-
P值		＜0.001	0.496	0.491	0.644

组别	例数	体重指数(kg/m²)
组别	例数	术前	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	40.04±3.63	29.96±3.66	27.54±3.09	27.96±3.69	28.84±4.37
LSG联合HHR	16	38.13±3.64	27.81±3.89	26.55±3.95	26.59±3.74	27.64±4.02
F值		2.857	3.393	0.863	1.415	0.828
P值		0.098^a	0.072^a	0.358^a	0.241^a	0.368^a
组别	例数	%EWL(%)
组别	例数	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	69.84±22.13	85.86±20.87	82.78±25.16	77.60±27.13
LSG联合HHR	16	82.86±24.64	92.60±28.31	91.08±27.07	82.21±27.47
F值		3.295	0.830	1.065	0.294
P值		0.076^a	0.367^a	0.308^a	0.590^a
组别	例数	%TWL(%)
组别	例数	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	25.18±6.26	31.13±5.89	30.03±7.96	27.95±8.63
LSG联合HHR	16	27.12±6.47	30.38±7.66	30.13±8.31	27.32±9.34
F值		0.968	0.134	0.002	0.052
P值		0.331^a	0.716^a	0.969^a	0.820^a

References 28

[1]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库：2022 年度报告[J/OL]. 中华肥胖与代谢病电子杂志, 2023, 9(2): 83-91.
[2]	朱利勇, 高祥, 李鹏洲, 等. 腹腔镜袖状胃切除术规范化操作要点[J]. 中华消化外科杂志, 2024, 23(8)：1044-1048.
[3]	DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: A national analysis[J]. JAMA Surg, 2014, 149(4): 328-334.
[4]	Merrouche M, Sabaté JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery[J]. Obes Surg, 2007, 17(7): 894-900.
[5]	Chan DL, Wong SK, Lok HT, et al. Accuracy of hiatal hernia diagnosis in bariatric patients: Preoperative endoscopy versus intraoperative reference[J]. JGH Open, 2020, 4(6): 1074-1078.
[6]	Gorodner V, Viscido G, Signorini F, et al. Gastroesophageal reflux disease and morbid obesity: Evaluation and treatment[J]. Updates Surg, 2018, 70(3): 331-337.
[7]	张松泽, 夏建福, 陈浩, 等. 袖状胃切除同期食管裂孔疝修补防止胃食管反流的疗效[J]. 中华普通外科杂志, 2022, 37(2): 94-98.
[8]	艾克拜尔·艾力, 皮尔地瓦斯·麦麦提玉素甫, 阿巴伯克力·乌斯曼, 等. 腹腔镜袖状胃切除术联合食管裂孔疝修补术在治疗肥胖合并胃食管反流病的应用价值[J/OL]. 中华胃食管反流病电子杂志, 2020, 7(1): 41-45.
[9]	Hider AM, Bonham AJ, Carlin AM, et al. Impact of concurrent hiatal hernia repair during laparoscopic sleeve gastrectomy on patient-reported gastroesophageal reflux symptoms: A state-wide analysis[J]. Surg Obes Relat Dis, 2023, 19(6): 619-625.
[10]	Dakour Aridi H, Asali M, Fouani T, et al. Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair: an Unresolved Question[J]. Obes Surg, 2017,27(11): 2898-2904.
[11]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 肥胖与代谢病外科疗效报告的标准规范[J/OL]. 中华肥胖与代谢病电子杂志, 2020, 6(2): 73-77.
[12]	Salminen P, Grönroos S, Helmiö M, et al. Effect of laparoscopic sleeve gastrectomy vs roux-en-y gastric bypass on weight loss,comorbidities, and reflux at 10 years in adult patients with obesity:The sleevepass randomized clinical trial[J]. JAMA Surg, 2022,157(8): 656-666.
[13]	Raj PP, Bhattacharya S, Misra S, et al. Gastroesophageal reflux-related physiologic changes after sleeve gastrectomy and roux-en-y gastric bypass: A prospective comparative study[J]. Surg Obes Relat Dis, 2019, 15(8): 1261-1269.
[14]	Dang JT, Vaughan T, Mocanu V, et al. Conversion of sleeve gastrectomy to roux-en-y gastric bypass: Indications, prevalence, and safety[J]. Obes Surg, 2023, 33(5): 1486-1493.
[15]	Chang P, Friedenberg F. Obesity and gerd[J]. Gastroenterol Clin North Am, 2014, 43(1): 161-173.
[16]	Miron I, Dumitrascu DL. Gastrointestinal motility disorders in obesity[J]. Acta Endocrinol (Buchar), 2019, 15(4): 497-504.
[17]	Ringhofer C, Lenglinger J, Riegler M, et al. Waist to hip ratio is a better predictor of esophageal acid exposure than body mass index[J]. Neurogastroenterol Motil, 2017, 29(7).
[18]	King K, Sudan R, Bardaro S, et al. Assessment and management of gastroesophageal reflux disease following bariatric surgery[J]. Surg Obes Relat Dis, 2021, 17(11): 1919-1925.
[19]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 精准肥胖代谢外科手术中国专家共识(2022 版)[J]. 中华消化外科杂志,2022, 21(10): 1302-1312.
[20]	屈坤鹏, 伊同英, 张琪, 等. 食管裂孔疝的手术干预策略[J]. 中华消化外科杂志, 2023, 22(9): 1059-1065.
[21]	Santonicola A, Angrisani L, Cutolo P, et al. The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients[J]. Surg Obes Relat Dis, 2014, 10(2): 250-255.
[22]	Şen O, Sekmen Ü, Türkçapar AG. The Effect of Laparoscopic Sleeve Gastrectomy With Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease[J]. Surg Laparosc Endosc Percutan Tech, 2022, 32(4): 449-452.
[23]	Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial[J]. JAMA, 2018, 319(3): 255-265.
[24]	Angrisani L, Santonicola A, Borrelli V, et al. Sleeve gastrectomy with concomitant hiatal hernia repair in obese patients: long-term results on gastroesophageal reflux disease[J]. Surg Obes Relat Dis,2020, 16(9): 1171-1177.
[25]	Boru CE, Coluzzi MG, de Angelis F, et al. Long-Term Results After Laparoscopic Sleeve Gastrectomy with Concomitant Posterior Cruroplasty: 5-Year Follow-up[J]. J Gastrointest Surg, 2020, 24(9):1962-1968.
[26]	Chen W, Feng J, Wang C, et al. Effect of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastroesophageal reflux disease in patients with obesity: A systematic review and meta-analysis[J]. Obes Surg, 2021, 31(9): 3905-3918.
[27]	Crawford C, Gibbens K, Lomelin D, et al. Sleeve gastrectomy and anti-reflux procedures[J]. Surg Endosc, 2017, 31(3): 1012-1021.
[28]	玉素江·图荪托合提, 麦麦提艾力·麦麦提明, 艾克拜尔·艾力. 肥胖在胃食管反流病发生发展中的作用机制[J]. 中华消化外科杂志, 2024, 23(1): 147-152.

Please choose a citation manager

Content to export