目的:减肥手术后未解决的术后反流的发生率差异很大。预测未解决反流的一致围手术期患者特征仍然未知。我们利用我们机构的全面术前食管检测来确定术后反流的预测因子。
方法:我们对2015年至2021年接受垂直袖状胃切除术(VSG)或Roux-en-Y胃旁路术(RYGB)的术前有反流症状的成年患者进行了单中心回顾性分析。所有患者术前进行pH值和高分辨率测压。通过Fisher精确检验探讨术后1年未解决反流的预测因素,KruskalWallis测试,和单变量逻辑回归。
结果:接受VSG的患者的未解决反流较高(n=60/129,46.5%)。RYGB(n=19/98,19.4%)。DeMeester中位数得分较高(22vs.13,p=.07)以及无效食管运动(IEM)的发生率(31.6vs.8.9%,与已解决的RYGB返流队列相比,在19例(19.3%)RYGB术后未解决的患者中,p=.01)。60例(46.5%)VSG患者术后反流未解决。VSG未解决的反流队列与已解决的VSG组的DeMeester和IEM发生率中位数相似,但术前吞咽困难更多(13.3%vs.2.9%,p=.04)和术前PPI使用率较高(56.7vs.39.1%,p=.05)。在单变量分析中,只有IEM可预测RYGB后未解决的反流(OR4.74,95%CI1.37,16.4).
结论:VSG后未解决的反流较高。术前IEM可预测RYGB后未解决的反流症状。在VSG患者中,术前吞咽困难症状和PPI使用预测未解决的反流,尽管与客观测试缺乏相关性突出了症状的主观性和预测术后症状的挑战.
OBJECTIVE: The incidence of unresolved postoperative reflux after bariatric surgery varies considerably. Consistent perioperative patient characteristics predictive of unresolved reflux remain unknown. We leverage our institution\'s comprehensive preoperative esophageal testing to identify predictors of postoperative reflux.
METHODS: We performed a single-center retrospective review of adult patients with preoperative reflux symptoms who underwent either vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2021. All patients had pH and high-resolution manometry preoperatively. Predictors of postoperative unresolved reflux at 1 year were explored via Fisher\'s exact test, Kruskal Wallis test, and univariate logistic regression.
RESULTS: Unresolved reflux was higher in patients undergoing VSG (n = 60/129,46.5%) vs. RYGB (n = 19/98, 19.4%). Median DeMeester scores were higher (22 vs. 13, p = .07) along with rates of ineffective esophageal motility (IEM) (31.6 vs. 8.9%, p = .01) in the 19 (19.3%) patients with unresolved postoperative reflux after RYGB compared to the resolved RYGB reflux cohort. Sixty (46.5%) of VSG patients had unresolved postoperative reflux. The VSG unresolved reflux cohort had similar median DeMeester and IEM incidence to the resolved VSG group but more preoperative dysphagia (13.3% vs. 2.9%, p = .04) and higher preoperative PPI use (56.7 vs. 39.1%, p = .05). In univariate analysis, only IEM was predictive of unresolved reflux after RYGB (OR 4.74, 95% CI 1.37, 16.4).
CONCLUSIONS: Unresolved reflux was higher after VSG. Preoperative IEM predicted unresolved reflux symptoms after RYGB. In VSG patients, preoperative dysphagia symptoms and PPI use predicted unresolved reflux though lack of correlation to objective testing highlights the subjective nature of symptoms and the challenges in predicting postoperative symptomatology.