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首页> 外文期刊>Surgical Endoscopy >Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn.
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Comparison of objective outcomes following laparoscopic Nissen fundoplication versus laparoscopic gastric bypass in the morbidly obese with heartburn.

机译：患有胃灼热的病态肥胖患者的腹腔镜尼森胃底折叠术与腹腔镜胃旁路手术后的客观结局比较。

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摘要

Background: Heartburn and gastroesophageal reflux disease (GERD) affects approximately 25-50% of morbidly obese patients. Although objective physiologic testing has been reported extensively in patients following Nissen fundoplication, there are no previous reports of such testing in morbidly obese patients. A life-saving surgical alternative for the morbidly obese patient is gastric bypass surgery, which usually improves heartburn symptoms in addition to many serious health conditions such as diabetes, hypertension, and sleep apnea. We hypothesized that, in morbidly obese patients, gastric bypass surgery would be as effective as Nissen fundoplication in reducing both heartburn symptoms and esophageal acid exposure, as reflected by the DeMeester score. Methods: Between 1995 and 2000, all patients undergoing laparoscopic Nissen fundoplication (LN) and laparoscopic gastric bypass (LGB) in our practice underwent preoperative and postoperative esophageal physiologic testing. Patients were included in this study that were morbidly obese and had significant heartburn symptoms or objective evidence of acid reflux, and had repeat esophageal physiologic testing after either LN or LGB. Data were obtained through retrospective review of prospectively collected data. Results: Twelve patients met the inclusion criteria: six patients who had LN and six who had LGB. The mean body mass index (BMI) was 55 kg/m(2) in the LGB group and 39.8 in the LN group. After surgery, the mean DeMeester score decreased from 64.3 to 2.8 in the LN group ( p = 0.01) and from 34.7 to 5.7 in the LGB group ( p = 0.1). Both groups' mean postoperative DeMeester scores were normal after surgery, and there was no significant difference between the two groups ( p = 0.3). Both groups experienced a significant improvement in heartburn symptoms postoperatively. The mean preoperative symptom score improved from 3.5 to 0.5 in the LN group ( p = 0.01) and from 2.2 to 0.2 in the LGB group ( p = 0.003). There was no difference in the mean postoperative symptom scores between the groups ( p = 0.35). After surgery, mean LES resting pressures increased from 12.9 to 35.5 ( p = 0.003) in the LN group and from 23.6 to 29.7 ( p = 0.45) in the LGB group. There were no complications in either group. Conclusion: Results of this study show that laparoscopic gastric bypass and laparoscopic Nissen fundoplication are both effective in treating heartburn symptoms and objective acid reflux in morbidly obese patients. The health benefits of weight loss after laparoscopic gastric bypass should make this operation the procedure of choice in the morbidly obese patient with heartburn.
机译：背景：胃灼热和胃食管反流病（GERD）影响约25-50％的病态肥胖患者。尽管在Nissen胃底折叠术后的患者中已广泛报道了客观的生理学检查，但以前在病态肥胖患者中没有进行这种检查的报道。对于病态肥胖患者而言，挽救生命的手术替代方法是胃搭桥手术，该手术通常可以改善烧心症状，此外还可以缓解许多严重的健康状况，例如糖尿病，高血压和睡眠呼吸暂停。我们假设，在病态肥胖的患者中，胃旁路手术在减少烧心症状和食道酸暴露方面与尼森胃底折叠术一样有效，如DeMeester评分所示。方法：在1995年至2000年期间，我们对所有接受腹腔镜Nissen胃底折叠术（LN）和腹腔镜胃搭桥术（LGB）的患者进行了术前和术后食道生理检查。纳入本研究的患者是病态肥胖，有明显的烧心症状或酸倒流的客观证据，并在LN或LGB后进行了重复的食管生理检查。通过回顾性收集预期收集的数据获得数据。结果：12名患者符合纳入标准：6名LN患者和6名LGB患者。 LGB组的平均体重指数（BMI）为55 kg / m（2），LN组的平均体重指数为39.8。手术后，LN组的平均DeMeester评分从64.3降至2.8（p = 0.01），LGB组的平均DeMeester评分从34.7降至5.7（p = 0.1）。两组术后平均DeMeester评分在手术后均正常，并且两组之间无显着差异（p = 0.3）。两组术后胃灼热症状均有明显改善。 LN组术前平均症状评分从3.5改善到0.5（p = 0.01），LGB组从2.2改善到0.2（p = 0.003）。两组之间的平均术后症状评分无差异（p = 0.35）。手术后，LN组的平均LES静息压力从12.9增加到35.5（p = 0.003），LGB组的平均LES静息压力从23.6增加到29.7（p = 0.45）。两组均无并发症。结论：本研究结果表明，腹腔镜胃旁路术和尼森胃底折叠术均能有效治疗病态肥胖患者的胃灼热症状和客观酸反流。腹腔镜胃旁路手术减轻体重对健康的益处应使该手术成为肥胖病伴胃灼热病患者的首选手术。

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