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1.
Treatment of morbid obesity with laparoscopic adjustable gastric banding affects esophageal motility 总被引:11,自引:0,他引:11
Weiss HG Nehoda H Labeck B Peer-Kühberger MD Klingler P Gadenstätter M Aigner F Wetscher GJ 《American journal of surgery》2000,180(6):479-482
BACKGROUND: Laparoscopic adjustable gastric banding has become the prefered method for the surgical treatment of morbid obesity in Europe. It is not known whether this procedure may induce gastroesophageal reflux and whether it may impair esophageal peristalsis. METHODS: Laparoscopic adjustable gastric banding (Swedish band) was performed in 43 patients (median body mass index [BMI] 42.5 kg/m(2)). Preoperatively and 6 months postoperatively all patients were assessed for reflux symptoms. In addition all patients underwent preoperative and postoperative endoscopy, esophageal barium studies and manometry, and 24-hour esophageal pH-monitoring. RESULTS: The median BMI dropped significantly to 33.1 kg/m(2) (P <0.05). Preoperatively 12 patients complained of reflux symptoms. Mild esophagitis was detected in 10 patients. Postoperatively only 1 patient complained of heartburn and mild esophagitis was diagnosed in another patient. None of the patients had dysphagia. Preoperatively a defective LES and pathologic pH-testing were found in 9 and 15 patients, respectively. These parameters were normal in all of the patients postoperatively. Postoperatively there was significant impairment of LES relaxation and deterioration of esophageal peristalsis with dilatation of the esophagus in some of the patients. CONCLUSION: Laparoscopic adjustable gastric banding provides a sufficient antireflux barrier and therefore prevents pathologic gastroesophageal reflux. However, it impairs relaxation of the LES, leading to weak esophageal peristalsis. 相似文献
2.
BACKGROUND: Restrictive bariatric procedures are frequently considered for patients with morbid obesity, because the weight loss and reduction of comorbidities are good. An impact on gastroesophageal reflux disease (GERD), which is common in this population, may be anticipated. Converse results of GERD symptoms are reported for patients after adjustable gastric banding (AGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGBP). METHODS: A literature search was performed and, with our personal experience, are summarized. RESULTS: Esophageal manometry is a practical tool to identify functional disorders of the esophageal body and the lower esophageal sphincter (LES). For patients with weak esophageal body motility, AGB should not be considered as a therapeutic option because esophageal dilation, esophageal stasis, and consequent esophagitis often occur during long-term follow-up, and band deflation is inevitable. Stable body weight can therefore not be achieved in these patients. Low resting pressure of the LES may be a contraindication for SG, because taking away the angle of His further impairs the antireflux mechanism at the cardia. So far, RYGBP is an option for all morbidly obese patients regardless of the results of esophageal manometry. CONCLUSION: Preoperative esophageal manometry is advised for restrictive procedures such as AGB and SG. 相似文献
3.
Hong D Khajanchee YS Pereira N Lockhart B Patterson EJ Swanstrom LL 《Obesity surgery》2004,14(6):744-749
Background: Obesity is an epidemic in the USA. Many disorders are associated with obesity including gastroesophageal reflux
disease (GERD). However, the prevalence of GERD and esophageal motility disorders in the morbidly obese population is unclear.
Methods: During evaluation for bariatric surgery, 61 morbidly obese patients underwent preoperative 24-hr pH and esophageal
manometry. A single reviewer evaluated all 24-hr pH and manometric tracings. Johnson-DeMeester score >14.7 was considered
diagnostic of GERD. Manometric criteria for motility disorders were from published values. All values are given as mean ±
SD. Results: Mean age was 44.4 + 10.3 years. 55 of the patients (90%) were female. Mean BMI was 50.1 ± 7.2 kg/m2. 23 patients (38%) complained of GERD symptoms (reflux and/or heartburn). 1 patient (2%) complained of noncardiac chest pain.
Mean Johnson-DeMeester score was 19.6 ± 17.8. Mean intragastric and intrabolus pressures were both elevated (8.3 ± 1.6 mmHg
and 15 ± 9 mmHg). 33 patients (54%) had abnormal manometric findings: 10 had a mechanically defective LES, 11 had a hypertensive
LES, 2 had diffuse esophageal spasm, 3 had nutcracker esopha gus,1 had ineffective esophageal disorder and 14 had nonspecific
esophageal motility disorder. Some patients had more than one disorder. 20 patients (33%) had significantly elevated (>180
mmHg) contraction amplitudes at the most distal channel (210.0 ± 28.7 mmHg). Conclusions: Prevalence of manometric abnormalities
in the morbidly obese is high. Presence of a nut cracker-like distal esophagus in the morbidly obese is significant and warrants
further evaluation. 相似文献
4.
Fernando A. M. Herbella Matthew P. Sweet Pietro Tedesco Ian Nipomnick Marco G. Patti 《Journal of gastrointestinal surgery》2007,11(3):286-290
Although the etiology of gastroesophageal reflux disease (GERD) is multifactorial, the pathophysiology of the disease in morbidly
obese patients remains incompletely understood. The aims of this study were to compare in morbidly obese (body mass index
(BMI) ≥35) and nonmorbidly patients (BMI <35) with GERD: (a) lower esophageal sphincter (LES) profile; (b) esophageal body
function; and (c) esophageal acid exposure. We reviewed esophageal manometry and ambulatory 24-hour pH monitoring studies
of 599 consecutive patients with GERD (DeMeester score >14.7). Patients were divided into two groups according to the BMI:
(1) 520 patients (86.8%) with BMI <35 and (2) 79 patients (13.2%) with BMI ≥35. While the DeMeester score was not different
between the two groups, morbidly obese patients had higher LES pressure and higher amplitude of peristalsis in the distal
esophagus (DEA). Among these patients, LES and DEA pressures were often hypertensive. A linear regression model showed that
BMI, LES pressure, LES abdominal length, and DEA were independently associated with the DeMeester score. These data showed
that: (a) BMI was independently associated to the severity of GERD; and (b) in most morbidly obese patients with GERD, reflux
occurred despite normal or hypertensive esophageal motility. These findings show that the pathophysiology of GERD in morbidly
obese patients might differ from that of nonobese patients, suggesting the need for a different therapeutic approach.
Presented at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, Los Angeles, CA, May 22–24, 2006. 相似文献
5.
Klaus A Gruber I Wetscher G Nehoda H Aigner F Peer R Margreiter R Weiss H 《Archives of surgery (Chicago, Ill. : 1960)》2006,141(3):247-251
HYPOTHESIS: Preexisting gastroesophageal reflux disease (GERD) and esophageal motility disorders may affect the outcome of laparoscopic adjustable gastric banding (AGB). DESIGN: Prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Between January 1, 1996, and December 31, 2002, AGB procedures were performed in 587 patients (mean body mass index, 46.7 [calculated as weight in kilograms divided by the square of height in meters]). The study population was composed of patients with preoperative GERD (assessed by a symptom-score questionnaire) and was divided into group 1 (those with preoperative GERD symptoms only) and group 2 (those with preoperative and postoperative GERD symptoms). INTERVENTIONS: Laparoscopic AGB was performed according to the pars-flaccida technique. MAIN OUTCOME MEASURES: All patients underwent preoperative and annual postoperative symptom scoring, endoscopy, esophageal barium swallow tests, esophageal manometry, and 24-hour pH monitoring. RESULTS: Mean follow-up time was 33 months (range, 12-49 months). A total of 164 patients (27.9%) were diagnosed as having preoperative GERD symptoms. In 112 (68.3%) of these patients GERD symptoms vanished postoperatively (group 1), whereas 52 patients (31.7%) remained symptomatic after undergoing laparoscopic AGB implantation (group 2). Preoperatively, group 2 patients showed significantly poorer esophageal body motility compared with group 1 patients (20.8% vs 12.8% defective propagations; P = .007). In group 2 the mean symptom scores for dysphagia (0.4 vs 0.9) and regurgitation (0.6 vs 1.4) deteriorated significantly following laparoscopic AGB implantation, respectively. Eighteen patients (34.6%) in group 2 developed esophageal dilatation. CONCLUSIONS: Adjustable gastric banding provides a sufficient antireflux barrier in most of the obese patients with GERD. However, in patients with preoperatively defective esophageal body motility, AGB may aggravate GERD symptoms and esophageal dilatation. Alternative bariatric surgical procedures should be considered in these patients. 相似文献
6.
Koppman JS Poggi L Szomstein S Ukleja A Botoman A Rosenthal R 《Surgical endoscopy》2007,21(5):761-764
Background Most studies investigating esophageal motility among the morbidly obese have focused on the relationship between lower esophageal
sphincter (LES) pressure and gastroesophageal reflux disease (GERD). Very few studies in the literature have examined motility
disorders among the morbidly obese population in general outside the context of GERD. This study aimed to determine the prevalence
of esophageal motility disorders in obese patients selected for bariatric surgery.
Methods A total of 116 obese patients (81 women and 35 men) selected for laparoscopic gastric banding underwent manometric evaluation
of their esophagus from January to March 2003. Tracings were retrospectively reviewed for the end points of LES resting pressure,
LES relaxation, and esophageal peristalsis.
Results The study patients had a body mass index (BMI) of 42.9 kg/m2, and a mean age of 48.6 years. The following abnormal manometric findings were demonstrated in 41% of the patients: nonspecific
esophageal motility disorders (23%), nutcracker esophagus (peristaltic amplitude >180 mmHg) (11%), isolated hypertensive LES
pressure (>35 mmHg) (3%), isolated hypotensive LES pressure (<12 mmHg) (3%), diffuse esophageal spasm (1%), and achalasia
(1%). Only one patient with abnormal esophageal motility reported noncardiac chest pain.
Conclusions Despite a high prevalence of esophageal dysmotility in our morbidly obese study population, there was a conspicuous absence
of symptoms. Although the patients in this study were not directly questioned with regard to esophageal symptoms, several
studies in the literature support our conclusion.
Podium presentation at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), 26–29 April
2006, Dallas, TX, USA 相似文献
7.
Ortega J Escudero MD Mora F Sala C Flor B Martinez-Valls J Sanchiz V Martinez-Alzamora N Benages A Lledo S 《Obesity surgery》2004,14(8):1086-1094
Background: One of the co-morbidities frequently associated with morbid obesity is gastro-esophageal reflux disease (GERD),
present in >50 % of morbidly obese individuals. We compared the anti-reflux effect of vertical banded gastroplasty (VBG) and
Roux-en-Y gastric bypass (RYGBP), and their effect on esophageal function. Methods: 10 patients underwent VBG and 40 patients
underwent RYGBP. Anthropometric parameters, symptomatology of GERD, esophageal manometry (EM), isotopic esophageal emptying
(IEE) and 24hr esophageal pH monitoring were recorded in all patients preoperatively, and at 3 months and 1 year postoperatively.
Results: Preoperatively, there was a high prevalence of GERD, symptomatic and pH-metric in both groups (57% and 80% respectively).
The preoperative values of EM and IEE parameters were within the normal range in most patients. After surgery, there was an
improvement at 3 months postoperatively in both groups. 1 year after surgery, the VBG group presented symptomatic GERD in
30% and pH-metric reflux in 60% of patients while the RYGBP group presented symptomatic GERD and pH-metric reflux in 12.5%
and 15% of patients, respectively. There was an increase in postoperative sensation of dysphagia in both groups (70% VBG,
30% RYGBP) one year after operation. After surgery, differences in all EM parameters were minimal, and never reached statistical
significance for any group (VBG and RYGBP). The IEE showed a significantly higher percentage of esophageal retention after
surgery, but this retention was always within the normal range. Both groups had an improvement in anthropometric parameters,
but 1 year after surgery the results were significantly better in RYGBP patients (70% excess weight loss) than in VBG patients
(46% excess weight loss). Conclusion: >50% of morbidly obese individuals suffer from GERD. We did not find changes in esophageal
function of morbidly obese patients to explain their gastroesophageal reflux preoperatively and postoperatively. EM and IEE
studies are not indicated as standard preoperative tests, except in patients with significant symptoms of gastroesophageal
reflux. RYGBP is significantly better than VBG as an anti-reflux procedure, and had better weight loss. 相似文献
8.
Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients before and after Bariatric Surgery 总被引:6,自引:6,他引:0
Merrouche M Sabaté JM Jouet P Harnois F Scaringi S Coffin B Msika S 《Obesity surgery》2007,17(7):894-900
Background Obesity is a predisposing factor to gastro- esophageal reflux disease (GERD), but esophageal function remains poorly studied
in morbidly obese patients and could be modified by bariatric surgery.
Methods Every morbidly obese patient (BMI ≥40 kg/m2 or ≥35 in association with co-morbidity) was prospectively included with an evaluation of GERD symptoms, endoscopy, 24-hour
pH monitoring and esophageal manometry before and after adjustable gastric banding (AGB) or Roux-en-Y gastric bypass (RYGBP).
Results Before surgery, 100 patients were included (84 F, age 38.4 ± 10.9 years, BMI 45.1 ± 6.02 kg/m2), of whom 73% reported GERD
symptoms. Endoscopy evidenced hiatus hernia in 39.4% and esophagitis in 6.4%. The DeMeester score was pathological in 53.3%;
69% of patients had lower esophageal sphincter (LES) pressure <15 mmHg and 7 had esophageal dyskinesia. BMI was significantly
related to the DeMeester score (P = 0.018) but not to LES tone or esophageal dyskinesia. Postoperative data were available in 27 patients (AGB n = 12/60, RYGBP
n = 15/36). The DeMeester score (normal <14.72) was significantly decreased after RYGBP (24.8 ± 13.7 before vs 5.8 ± 4.9 after;
P < 0.001) but tended to increase after AGB (11.5 ± 5.1 before vs 51.7 ± 70.7 after; P = 0.09), with severe dyskinesia in 2 cases. Conclusion: GERD and LES incompetence are highly prevalent in morbidly obese
patients. Preliminary postoperative data show different effects of RYGBP and AGB on esophageal function, with worsening of
pH-metric data with occasional severe dyskinesia after AGB. 相似文献
9.
Changes in Esophageal Function after Vertical Banded Gastroplasty as Demonstrated by Esophageal Scintigraphy 总被引:1,自引:0,他引:1
Keith Seymour MB FRCS Alison Mackie PhD Elizabeth McCauley MSc John G Stephen MB MChir FRCS 《Obesity surgery》1998,8(4):429-433
Background: The effects of surgery for morbid obesity on the function of the upper gastrointestinal (GI) tract are of interest
to bariatric surgeons. This study was undertaken to determine any changes in esophageal function, following vertical banded
gastroplasty (VBG) in morbidly obese patients, as detected by esophageal scintigraphy. Methods: Ten consecutive morbidly obese
patients (six female and four male) underwent preoperative esophageal scintigraphy and upper GI endoscopy. These investigations
were repeated 12 months after VBG to coincide with expected appreciable weight reduction. The results were tabulated together
with body mass indices, crude weights and percentage excess weight lost. Results: Before VBG one patient gave a history of
mild heartburn, one had mild dyspepsia and the remaining eight patients had no GI symptoms. No patient had a hiatus hernia
or endoscopic evidence of reflux esophagitis. Preoperatively all patients had abnormal scintiscans. The abnormalities were
esophageal retention (all) and intraesophageal reflux (five out of 10 patients). Gastroesophageal reflux was not identified
in any patient. Postoperatively scintiscans were normal or improved in six out of 10 patients and unchanged in four out of
10 patients. In three patients the scans were normal and three showed overall improvement in esophageal function, although
in one of these latter patients gastroesophageal reflux was observed. Conclusions: In this series of morbidly obese patients,
esophageal function as assessed by scintigraphy was abnormal. Following VBG it improved in six out of 10 patients and was
unchanged in four out of 10. However, in one patient, who had shown an overall improvement in esophageal function, gastroesophageal
reflux was demonstrated when it had not been seen preoperatively. This was asymptomatic. Thus, adverse changes in esophageal
function after VBG were uncommon. 相似文献
10.
High Prevalence of Asymptomatic Esophageal Motility Disorders among Morbidly Obese Patients 总被引:4,自引:1,他引:3
Background: Morbid obesity is becoming more prevalent in the industrialized world. Few data exist regarding the resting lower
esophageal sphincter pressure (LESP) and esophageal motility in relationship to body mass index (BMI). Methods: During a 3-year
period, 111 of 152 morbidly obese patients seeking bariatric surgery completed esophageal manometric testing and questionnaire
regarding esophageal symptoms. Manometric parameters included wave amplitude and duration of esophageal contractions, percentage
of peristaltic function, and resting LESP. Questionnaire data included age, sex, medications, prior medical conditions, and
esophageal symptoms. Results: 88 (79%) of the patients were female; 23 (21%) were male. The mean age was 39.8 years (± 9.9),
the mean BMI was 50.7 kg/m2 (± 9.4). There was a lack of correlation between BMI and LESP (r = 0.04). Abnormal manometric
findings were observed in 68/111 (61%) patients: 28 (25%) had only hypotensive lower esophageal sphincter (LESP < 10 mm Hg);
16 (14%) had nutcracker esophagus (amplitude >180 mm Hg), 15 (14%) had nonspecific esophageal motility disorders, 8 (7%) had
diffuse esophageal spasm (DES), and 1 (1%) had achalasia. Patients with DES had a significantly higher BMI than those with
other motility disorders (P < 0.05). Dysphagia was reported in 7 (6%) patients and chest pain in 1 patient. Heartburn and/or
regurgitation (gastroesophageal reflux disease, GERD) was noted in 35 patients (32%), of whom 18 (51%) had a hypotensive resting
LES. 40 of 68 patients (59%) with abnormal motility tracings did not report any esophageal symptoms. Conclusion: Morbid obesity
per se does not imply an abnormality of LESP. In addition, a majority of morbidly obese patients who were considering bariatric
surgery had no esophageal symptoms but were found to have abnormal esophageal manometric patterns. These findings add support
to the suggestion that morbidly obese patients may have abnormal visceral sensation. 相似文献
11.
Lew JI Daud A DiGorgi MF Olivero-Rivera L Davis DG Bessler M 《Surgical endoscopy》2006,20(8):1242-1247
Background Laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity has been reported to provide long-term weight
loss with a low risk of operative complications. Nevertheless, esophageal dilation leading to achalasia-like and reflux symptoms
is a feared complication of LASGB. This study evaluates the clinical benefit of routine preoperative esophageal manometry
in predicting outcome after LASGB in morbidly obese patients.
Method A review of prospectively collected data on 77 patients who underwent routine esophageal manometry prior to LASGB for morbid
obesity from February 2001 to September 2003 was performed. Aberrant motility, abnormal lower esophageal sphincter (LES) pressures,
and other nonspecific esophageal motility disorders noted on preoperative esophageal manometry defined patients of the abnormal
manometry group. Outcome differences in weight loss, emesis, band complications, and gastroesophageal reflux disease (GERD)
resolution or improvement were compared between patients of the abnormal and normal manometry groups after LASGB. Analysis
of variance (ANOVA) and chi-square tests were performed to determine the significance of these outcomes.
Results Of the patients tested, 14 had abnormal esophageal manometry results, whereas 63 had normal manometry results before LASGB.
There was no significant difference in percent excess weight loss (%EWL) at 6 and 12 months between the groups after gastric
banding. Severe postoperative emesis occurred more frequently in patients with abnormal manometry results than in those with
normal manometry results. There were two band-related complications, both of which occurred in patients of the normal manometry
group.
Conclusions Preoperative esophageal manometry does not predict weight loss or GERD outcomes after LASGB in morbidly obese patients. Postoperative
emesis was more common in patients with abnormal manometry findings, but such symptoms were manageable and did not lead to
poor weight loss or to band removal or increased band-related complications.
Presented at the 2004 Resident and Fellow Scientific Session of the Society of American Gastrointestinal Endoscopic Surgeons
(SAGES), Denver, CO, March 31–April 3, 2004
Received a Poster of Distinction Award at the 2004 Scientific Session of the Society of American Gastrointestinal Endoscopic
Surgeons (SAGES), Denver, CO, March 31–April 3, 2004 相似文献
12.
Alterations of gut neuropeptides in gastroesophageal reflux disease are resolved after antireflux surgery 总被引:2,自引:0,他引:2
Gadenstätter M Prommegger R Klingler A Schwelberger H Weiss HG Glaser K Wetscher GJ 《American journal of surgery》2000,180(6):654-6; discussion 487
BACKGROUND: Gastroesophageal reflux disease (GERD) may cause alterations of gut neuropeptides such as motilin and neurotensin that are known to control foregut motility. The aim of this study was to investigate whether these alterations may be resolved following antireflux surgery. METHODS: Basal and postprandial plasma levels of motilin and neurotensin were measured in 20 GERD patients preoperatively and 6 months after antireflux surgery. There were 9 patients with normal esophageal peristalsis and 11 with poor esophageal body motility. Eleven healthy subjects served as control group. RESULTS: GERD patients with poor esophageal body motility had low basal plasma levels of motilin and high levels of neurotensin. Postprandial motilin levels were significantly increased in these GERD patients. After antireflux surgery, all observed alterations of gut neuropeptides returned to normal values. CONCLUSION: Alterations of gut neuropeptides may be implicated in the pathophysiology of impaired esophageal peristalsis in GERD. Antireflux surgery restores normal physiology of gut neuropeptides. This may contribute to improvement of foregut motility in GERD, thus counteracting duodenogastric reflux. 相似文献
13.
Alberto Zalar Baya Haddouche Michel Antonietti Raied Alhameedi Isabelle Iwanicki-Caron Stéphane Lecleire Philippe Ducrotté 《Obesity surgery》2013,23(11):1939-1941
The relationship between obesity and gastroesophageal reflux disease (GERD) is a subject of debate. In this large series of 250 morbidly obese patients, all candidates for bariatric surgery, we have shown the very low prevalence of severe GERD and neither Barrett’s esophagus nor esophageal adenocarcinoma was detected. Moreover, no relationship was found between GERD and not only BMI but also abdominal diameter. 相似文献
14.
Otto Riedl Michael Gadenstätter Wolfgang Lechner Gerhard Schwab Martina Marker Ruxandra Ciovica 《Journal of gastrointestinal surgery》2009,13(7):1189-1197
Background Experience with laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) and manometrically
intact lower esophageal sphincter (LES) is limited. The disease pattern may be different and LARS may fail to control reflux
or result in higher rates of dysphagia. This is the first study investigating the impact of preoperative LES manometry data
not only on manifestations of GERD and subjective outcome alone but also on objective outcomes 1 year after LARS.
Methods Three hundred fifty-one GERD patients underwent LARS and had subjective symptom and quality of life assessment, upper gastrointestinal
endoscopy, barium swallow esophagogram, 24-h esophageal pH monitoring, and manometry pre- and 1 year postoperatively. Patients
were divided into those with a preoperatively intact versus defective LES based on intraabdominal length and resting pressure.
Baseline and 1-year postoperative follow-up data were compared.
Results Preoperative manifestations of GERD were similar in each group. Postoperatively, all symptoms except flatulence, quality of
life scores, and objective manifestations improved significantly in each group.
Conclusions The preoperative manometric character of the LES neither impacts the manifestations of GERD nor subjective and objective outcomes after LARS. Patients with GERD and manometrically intact LES have no higher risk for postoperative
dysphagia. 相似文献
15.
Gastroesophageal reflux disease associated with poor esophageal body motility is effectively treated by laparoscopic toupet fundoplication 总被引:2,自引:0,他引:2
G. J. Wetscher M.D. K. Glaser M. Gadenstätter G. Perdikis R. Lund E. Bodner R. A. Hinder 《European Surgery》1996,28(1):49-54
Summary
Background The Nissen fundoplication, an effective treatment for gastroesophageal reflux disease (GERD), may frequently cause dysphagia
in patients with poor esophageal body motility.
Methods The laparoscopic Toupet fundoplication was performed in 24 patients with gastroesophageal reflux disease (GERD) with poor
esophageal body motility of whom 18 (75%) presented with intermittent (n=16) or persistent (n=2) dysphagia for solids. Patients
were followed-up for up to 12 months following surgery.
Results Perioperative complications occurred in 4 patients (16.7%) including gastric perforation (n=1), intraabdominal hematoma (n=1),
deep venous thrombosis of the calf (n=1) and pneumonia (n=1). There was no mortality and no conversion to open laparotomy
among our patients 95.8% of patients were satisfied with surgery (Visick grade 1 or 2). Postoperatively 2 patients (8.4%)
complained of dysphagia, one required reoperation due to too tight approximation of the hiatal crura.
Conclusions The laparoscopic Toupet fundoplication is an effective treatment for GERD with poor esophageal body motility.
相似文献
16.
Weiss HG Nehoda H Labeck B Peer-Kuehberger R Oberwalder M Aigner F Wetscher GJ 《Obesity surgery》2002,12(4):573-578
Background: Adjustable gastric banding and esophagogastric banding may affect the function of the lower esophageal sphincter
(LES) and esophageal motility in the long-term. Both methods were evaluated in a prospective randomized trial. Materials and
Methods: Group 1 comprised 28 patients who underwent laparoscopic adjustable gastric banding and Group 2 consisted of 24 patients
in whom adjustable esophagogastric banding was performed. Swedish Adjustable Gastric Bands? were used in all patients. Body
mass index (BMI), perioperative complications and reflux symptoms were assessed and upper gastrointestinal endoscopy, esophageal
barium studies, esophageal manometry and 24-hour esophageal pH-monitoring were performed pre- and postoperatively. 18 (Group
1) and 14 (Group 2) patients completed the postoperative follow-up procedure after a median of 23 and 24 months, respectively.
Results: Postoperatively the median BMI dropped equally in both groups. Perioperative complications requiring re-intervention
were significantly more frequent in Group 2 than in Group 1. Heartburn improved equally in both groups following surgery;
however, regurgitation and esophagitis were significantly more common in Group 2 than in Group 1.24-hour esophageal pH-monitoring
and the LES resting pressure improved equally in both groups, but there was a significant impairment of the LES relaxation
and the esophageal peristalsis, which was more pronounced in Group 2 than in Group 1. This caused significant esophageal stasis
as shown by barium studies. Conclusions: Both techniques, gastric and esophagogastric banding, provide effective weight loss
in morbidly obese patients but affect the esophagogastric junction. Although both procedures strengthen the antireflux-barrier,
LES relaxation becomes impaired, thus promoting esophageal dilatation and esophageal stasis. This is more pronounced following
esophagogastric banding than following the classic procedure. Since the esophagogastric banding results in more complications
requiring re-intervention, we believe that this procedure should not be used any more. 相似文献
17.
The prevalence of distal and proximal gastroesophageal reflux in patients awaiting lung transplantation
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Sweet MP Herbella FA Leard L Hoopes C Golden J Hays S Patti MG 《Annals of surgery》2006,244(4):491-497
OBJECTIVE: To determine the prevalence and proximal extent of gastroesophageal reflux (GERD) in patients awaiting lung transplantation. BACKGROUND: GERD has been postulated to contribute to accelerated graft failure in patients who have had lung transplantations. However, the prevalence of reflux symptoms, esophageal motility abnormalities, and proximal esophageal reflux among patients with end-stage lung disease awaiting lung transplantation are unknown. METHODS: A total of 109 patients with end-stage lung disease awaiting lung transplantation underwent symptomatic assessment, esophageal manometry, and esophageal pH monitoring (using a probe with 2 sensors located 5 and 20 cm above the lower esophageal sphincter). RESULTS: Reflux symptoms were not predictive of the presence of reflux (sensitivity, 67%; specificity, 26%). Esophageal manometry showed a high prevalence of a hypotensive lower esophageal sphincter (55%) and impaired esophageal peristalsis (47%) among patients with reflux. Distal reflux was present in 68% of patients and proximal reflux was present in 37% of patients. CONCLUSIONS: These data show that in patients with end-stage lung disease: 1) symptoms were insensitive and nonspecific for diagnosing reflux; 2) esophageal motility was frequently abnormal; 3) 68% of patients had GERD; 4) in 50% of the patients with GERD, acid refluxed into the proximal esophagus. We conclude that patients with end-stage lung disease should be screened with pH monitoring for GERD. 相似文献
18.
Shahin Ayazi Jeffrey A. Hagen Linda S. Chan Steven R. DeMeester Molly W. Lin Ali Ayazi Jessica M. Leers Arzu Oezcelik Farzaneh Banki John C. Lipham Tom R. DeMeester Peter F. Crookes 《Journal of gastrointestinal surgery》2009,13(8):1440-1447
Introduction Obesity and gastroesophageal reflux disease (GERD) are increasingly important health problems. Previous studies of the relationship
between obesity and GERD focus on indirect manifestations of GERD. Little is known about the association between obesity and
objectively measured esophageal acid exposure. The aim of this study is to quantify the relationship between body mass index
(BMI) and 24-h esophageal pH measurements and the status of the lower esophageal sphincter (LES) in patients with reflux symptoms.
Methods Data of 1,659 patients (50% male, mean age 51 ± 14) referred for assessment of GERD symptoms between 1998 and 2008 were analyzed.
These subjects underwent 24-h pH monitoring off medication and esophageal manometry. The relationship of BMI to 24-h esophageal
pH measurements and LES status was studied using linear regression and multiple regression analysis. The difference of each
acid exposure component was also assessed among four BMI subgroups (underweight, normal weight, overweight, and obese) using
analysis of variance and covariance.
Results Increasing BMI was positively correlated with increasing esophageal acid exposure (adjusted R
2 = 0.13 for the composite pH score). The prevalence of a defective LES was higher in patients with higher BMI (p < 0.0001). Compared to patients with normal weight, obese patients are more than twice as likely to have a mechanically defective
LES [OR = 2.12(1.63–2.75)].
Conclusion An increase in body mass index is associated with an increase in esophageal acid exposure, whether BMI was examined as a continuous
or as a categorical variable; 13% of the variation in esophageal acid exposure may be attributable to variation in BMI.
An erratum to this article can be found at 相似文献
19.
Abnormal esophageal acid exposure is common in morbidly obese patients and improves after a successful Lap-band system implantation 总被引:1,自引:1,他引:0
Iovino P Angrisani L Tremolaterra F Nirchio E Ciannella M Borrelli V Sabbatini F Mazzacca G Ciacci C 《Surgical endoscopy》2002,16(11):1631-1635
Background: The relation between gastro-esophageal reflux disease (GERD) and obesity is controversial. The laparoscopic adjustable
gastric band (LAGB) procedure is effective for morbid obesity. Its indication in the presence of GERD, however, is still debated.
This study aimed to investigate esophageal symptoms, motility patterns, and acid exposure in morbidly obese patients before
and after LAGB placement. Method: For this study, 43 consecutive obese patients were investigated by a standardized symptoms
questionnaire, stationary manometry and 24-h ambulatory pH-metry, and 16 patients with abnormal esophageal acid exposure were
reevaluated 18 months after LAGB placement. Results: Symptom scores and abnormal esophageal acid exposure were found to be
significantly higher, Lower Esophageal Sphincter (LOS) pressure was significantly lower in obese patients than in control
subjects. After LAGB, esophageal acid exposure was significantly reduced in all but two patients, who presented with proximal
of gastric pouch dilation. Conclusions: There is a high prevalence of GERD in the obese population. Uncomplicated LAGB placement
reduces the amount of acid in these patients with abnormal esophageal acid exposure. 相似文献
20.
Obesity and gastroesophageal reflux disease (GERD) are prevalent in Western populations. In obese patients, high-resolution manometry often shows altered gastroesophageal pressure gradients, promoting retrograde gastric content flow into the esophagus and esophagogastric junction disruption, leading to a hiatal hernia. Hernia recurrence is higher in the obese, and recurrence is seen regardless of the operative approach used. Bariatric surgery is the gold-standard treatment for GERD in obese patients, and symptom improvement varies depending on the specific bariatric procedure performed, Roux-en-Y (RYGB), laparoscopic adjustable gastric banding (LAGB), or sleeve gastrectomy (SG). Studies have shown these surgeries significantly improve GERD, but RYGB had the greatest effect. Limited data is available examining the progression or regression of Barrett’s following bariatric surgery. We currently recommend RYGB for morbidly obese patients with Barrett’s esophagus. 相似文献