比较腹腔镜下套筒胃切除术和裂孔疝修补术在减轻体重和缓解胃肠反流方面的临床效果。

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2025-04-03 eCollection Date: 2025-01-01 DOI:10.3389/fsurg.2025.1513695

Hussam Al Trabulsi, Dunia Al Trabulsi, Khadeja Alrefaie, Tala Muassess, Salman Yousuf Guraya

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引用次数: 0

摘要

有证据表明，如果在腹腔镜袖胃切除术（LSG）中发现裂孔疝，应进行修复，以防止术后新发胃食管反流病（GERD），或治疗已有的反流症状。有兴趣在LSG期间进行腹腔镜尼森氏底扩术（LNF）和裂孔疝修补术（HHR）。这项研究的目的是确定单独的裂孔脚修复是否足以控制症状。我们比较了合并HHR和合并HHR和LNF的LSG患者的手术时间、体重指数（BMI）和反流症状。材料和方法：我们回顾性分析合并HHR的LSG患者的临床资料。该队列分为有LNF组（1组）和无LNF组（2组）。收集患者术前BMI和GERD问卷（GERD- q）评分。然后将术前BMI和GERD-Q值与术后1个月、3个月和6个月的指标进行比较。分析两组患者的手术表现和时间记录。统计分析包括独立样本t检验、配对t检验和相关分析。结果：本研究共进行了978例减肥手术。431例LSG患者中，73例符合研究标准。两组术后BMI和GERD-Q评分均显著降低。第1组患者6个月BMI较术前平均38.03 ~ 32.17下降（p < p < p < p = 0.621）。结论：我们的短期研究结果显示，LSG和HHR患者在有或没有LNF的情况下，BMI和GERD症状有相似的改善。裂孔足部联合LSG的良好修复与足部修复联合LNF和LSG在减轻体重和缓解反流方面的效果相当。我们的短期结果不支持LNF联合LSG和HHR。进一步的研究是确定长期结果的必要条件。

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Comparing the clinical outcomes of laparoscopic sleeve gastrectomy and hiatal hernia repair with or without fundoplication for weight loss and gastrointestinal reflux resolution.

Introduction: Evidence suggests that hiatal hernia should be repaired if found during laparoscopic sleeve gastrectomy (LSG), either to prevent new-onset post-operative gastro-esophageal reflux disease (GERD), or to treat pre-existing reflux symptoms. There is interest in performing laparoscopic Nissen's fundoplication (LNF) along with hiatal hernia repair (HHR) during LSG. This study aimed to determine whether hiatal crural repair alone is adequate for symptomatic control. We compared operative time, body mass index (BMI), and reflux symptoms between those undergoing LSG with HHR vs. LSG with HHR and LNF.

Materials and methods: We retrospectively analyzed clinical data of patients who underwent LSG with HHR. This cohort was divided into those with LNF (group 1) and without LNF (group 2). We collected patients' pre-operative BMI and GERD Questionnaire (GERD-Q) scores. We then compared pre-operative BMI and GERD-Q values with post-operative indices at 1-month, 3-months, and 6-months. The patients' medical records for operative findings and time between both groups was analyzed. Statistical analyses included Independent Samples T-tests, Paired T-tests, and correlation analysis.

Results: In this study, 978 bariatric surgeries were performed. Of 431 LSG patients, 73 fulfilled the study criteria. Both groups showed significant reduction in BMI and GERD-Q scores post-operatively. Group 1 had a decrease in BMI from an average pre-operative value of 38.03-32.17 at 6 months (p < 0.001), and GERD-Q scores from 12.25 to 6.47 (p < 0.001). Group 2 showed a BMI decrease from 39.63 to 31.67 (p < 0.001) and GERD-Q scores from 11.54 to 6.93 (p < 0.001) at 6 months. Average operative time was similar in both groups, 76.41 and 79.15 min for group 1 and 2, respectively (p = 0.621).

Conclusion: Our research with short-term results reports similar improvement in BMI and GERD symptoms in patients with LSG and HHR with or without LNF. A sound repair of hiatal crura combined with LSG leads to comparable outcomes to crural repair combined with LNF and LSG for weight loss and reflux resolution. Our short-term results do not support LNF in combination with LSG and HHR. Further research is essential to determine the long-term outcomes.

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.