PDF(Pubmed)
Abstract：
Gastroesophageal reflux disease (GERD) is frequently seen in the Western population. Laparoscopic anti-reflux surgery (LARS) is effective in managing this condition. Obesity is strongly associated with GERD, and with the rising rate of obesity, there is, therefore, a concurrently increasing frequency of LARS performed. We aim to review the outcomes of LARS in patients with obesity, including the recurrence of GERD symptoms and peri-operative complications. A systematic review and meta-analysis were performed for articles from June 1992 to June 2022. The literature was reviewed for outcomes of LARS in patients with obesity (BMI≥30). Eligibility criteria included specific BMI, study design, type of surgery, and outcomes. The recurrence of symptoms and peri-operative complications were assessed. Thirty-one studies were thoroughly reviewed. Nine studies (five retrospective and four prospective) were selected for meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow, which included 1,499 patients with obesity and 5,521 without. Laparoscopic Nissen fundoplication was the most common procedure performed. The recurrence of symptoms was significantly lower in patients without obesity (p=0.0001). There was no statistically significant difference between patients with and without obesity in peri-operative complications, re-intervention, and early return to theatres. A higher recurrence rate of GERD symptoms post-LARS was reported in patients with obesity. Further research is required to decrease such risks and propose different methods, such as weight loss prior to surgery or Roux-en-Y (R&Y) gastric bypass. Risks and benefits should be considered by clinicians prior to offering LARS to patients with obesity.
摘要：
胃食管反流病（GERD）常见于西方人群。腹腔镜抗反流手术（LARS）可有效治疗这种疾病。肥胖与GERD密切相关，随着肥胖率的上升，有,因此,同时增加执行LARS的频率。我们的目的是回顾LARS在肥胖患者中的结果，包括GERD症状复发和围手术期并发症。对1992年6月至2022年6月的文章进行了系统评价和荟萃分析。对肥胖患者（BMI≥30）的LARS转归进行了文献综述。资格标准包括特定的BMI，研究设计，手术类型,和结果。评估症状复发和围手术期并发症。对31项研究进行了全面审查。选择9项研究（5项回顾性研究和4项前瞻性研究）进行荟萃分析，使用系统评价和荟萃分析（PRISMA）流程的首选报告项目，其中包括1,499名肥胖患者和5,521名无肥胖患者。腹腔镜Nissen胃底折叠术是最常见的手术。无肥胖患者的症状复发率明显较低（p=0.0001）。有肥胖和无肥胖患者围手术期并发症的差异无统计学意义,重新干预,早日回到剧院。据报道，肥胖患者LARS后GERD症状的复发率更高。需要进一步研究以降低此类风险并提出不同的方法，例如手术前的体重减轻或Roux-en-Y（R＆Y）胃旁路术。在向肥胖患者提供LARS之前，临床医生应考虑风险和益处。
