袖状胃切除术后食管裂孔疝伴胃食管反流病修正手术的疗效分析

Efficacy of revision surgery for hiatal hernia with gastroesophageal reflux disease after sleeve gastrectomy

摘要:

背景与目的 胃食管反流病（GERD）是袖状胃切除术（SG）常见并发症之一，尤其在合并食管裂孔疝时更易发生且症状顽固，显著影响患者术后生活质量。本研究旨在评估腹腔镜食管裂孔疝修补联合胃食管固定术在SG术后合并食管裂孔疝及严重GERD患者中的疗效，为临床提供修正手术的治疗参考。方法 回顾性分析2023年1月—2024年6月在复旦大学附属华山医院接受腹腔镜食管裂孔疝修补+胃食管固定术的9例SG术后严重GERD患者的临床资料。比较修正术前后GerdQ评分、内镜下反流性食管炎诊断比例、质子泵抑制剂（PPI）使用情况等指标，并记录手术相关数据及随访情况。结果 所有患者均顺利完成手术，无严重术中并发症，术后平均住院时间为5.22 d。术后平均随访15.27个月，GerdQ评分由术前的11.67±2.00下降至7.22±1.48；GerdQ评分≥8比例由100.00%降至44.44%，内镜下确诊GERD比例由88.89%降至11.11%，PPI使用率亦明显下降，差异均有统计学意义（均P<0.05）。结论 腹腔镜食管裂孔疝修补联合胃食管固定术可有效缓解SG术后合并食管裂孔疝患者的反流症状，具有良好的短期疗效和较高的安全性，值得在特定患者中推广应用。

Abstract:

Background and Aims Gastroesophageal reflux disease (GERD) is a common complication following sleeve gastrectomy (SG), particularly in patients with concomitant hiatal hernia, where symptoms tend to be more persistent and refractory, significantly impairing postoperative quality of life. This study aimed to evaluate the efficacy of laparoscopic hiatal hernia repair combined with gastroesophageal fixation in SG patients with severe GERD and hiatal hernia, providing clinical reference for revisional surgical strategies.Methods The clinical data of 9 patients with severe GERD after SG who underwent laparoscopic hiatal hernia repair and gastroesophageal fixation at Huashan Hospital, Fudan University, between January 2023 and June 2024 were retrospectively analyzed. GerdQ scores, proportion of endoscopically confirmed reflux esophagitis, and proton pump inhibitor (PPI) usage were compared before and after surgery. Surgical parameters and follow-up outcomes were also recorded.Results All patients successfully completed the surgery without major intraoperative complications, and the mean postoperative hospital stay was 5.22 d. After a mean follow-up period of 15.27 months, the GerdQ score significantly decreased from 11.67±2.00 to 7.22±1.48. The proportion of patients with GerdQ score≥8 decreased from 100.00% to 44.44%, and the rate of endoscopically confirmed GERD dropped from 88.89% to 11.11%; PPI use also significantly declined, with all differences reaching statistical significance (all P<0.05).Conclusion Laparoscopic hiatal hernia repair combined with gastroesophageal fixation can effectively alleviate reflux symptoms in SG patients with coexisting hiatal hernia, demonstrating favorable short-term efficacy and high safety. This approach may be a preferable surgical option for selected patients.