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首页> 外文期刊>Surgical Endoscopy >Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults
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Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults

机译：肥胖成人腹腔镜袖胃切除术后1年胃食管反流病症状和糜烂性食管炎增加

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We thank Elazary et al. for their interest in our article and greatly appreciate their comments. Although the effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) remains controversial, several studies have shown an increase in the prevalence of GERD after LSG. How to reduce postoperative GERD following LSG is an important question for consideration. Hiatal hernia is an important risk factor for developing GERD and its repair has been shown to decrease GERD symptoms after LSG [2, 3]. Our study revealed that the occurrence of erosive esophagitis after LSG is related to the presence of hiatal hernia after the operation. We agree that modification of the surgical technique may decrease the occurrence of postoperative hiatal hernia and thereby decrease the prevalence of GERD. All our patients underwent preoperative endoscopy and if a hiatal hernia was identified, crural repair was performed. The definition of hiatal hernia used in our study was the presence of a diaphragmatic indentation that was at least 2 cm distal to the Z-line and the proximal margins of the gastric mucosal folds. However, in using this definition, there was a probability of missing small hiatal hernias. In addition to hiatal hernia repair, we also make technical modifications in our LSG procedure to decrease stricture formation at the inci-sura angularis. We believe that this modification may also help reduce the incidence of postoperative GERD. GERD symptoms are often used for the assessment of GERD following LSG. However, it is worth noting that GERD symptoms are not consistent with the presence of erosive esophagitis. As demonstrated in our study, 40.1 % of patients who did not have postoperative GERD symptoms still had postoperative erosive esophagitis on endoscopy. Therefore, we propose that postoperative follow-up endoscopy is necessary to identify the true prevalence of postoperative GERD. Endoscopy could also show the anatomical changes in the gastric tube following modification in the surgical technique.
机译：我们感谢Elazary等。感谢他们对我们的文章的关注，并非常感谢他们的评论。尽管腹腔镜袖胃切除术（LSG）对胃食管反流病（GERD）的作用仍存在争议，但一些研究表明LSG术后GERD的患病率增加。 LSG术后如何减少术后GERD是需要考虑的重要问题。食管裂孔疝是发生GERD的重要危险因素，其修复已显示可减轻LSG术后的GERD症状[2，3]。我们的研究表明，LSG术后糜烂性食管炎的发生与术后裂孔疝的存在有关。我们同意手术技术的修改可以减少术后食管裂孔疝的发生，从而降低GERD的患病率。我们所有的患者都接受了术前内镜检查，如果发现了裂孔疝，则进行了关键修复。在我们的研究中，食管裂孔疝的定义是距Z线至少2 cm处和胃粘膜褶皱的近端边缘至少有2 cm的diaphragm肌凹陷。但是，在使用此定义时，可能会遗漏小裂孔疝。除了裂孔疝修补，我们还对LSG手术进行了技术修改，以减少角膜上缘狭窄的形成。我们相信，这种修饰也可能有助于减少术后GERD的发生率。 LSG后，GERD症状通常用于评估GERD。但是，值得注意的是，GERD症状与糜烂性食管炎的存在不一致。如我们的研究所示，在内镜检查中，没有术后GERD症状的患者中仍有40.1％仍然患有术后糜烂性食管炎。因此，我们建议术后随访内镜检查对于确定术后GERD的真正患病率是必要的。内窥镜检查还可显示在手术技术修改后胃管的解剖学变化。

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