Post-operative reflux esophagitis as a predictor of choice of restrictive operation in patients with metabolic syndrome.
DOI:
https://doi.org/10.26641/2307-0404.2020.1.200412Keywords:
obesity, metabolic syndrome, sleeve gastrectomy, gastroplication, fundoplication, laparoscopy, gastroesophageal reflux disease, reflux esophagitisAbstract
The purpose of this study was to conduct a comparative analysis of the retrospective results of laparoscopic sleeve gastrectomy (LSG), laparoscopic gastroplication (LGP) and laparoscopic fundogastroplication (LFGP) (simultaneous performance of fundoplication by Nissen and gastroplication) obtained at the follow-up period of 1 year, to evaluate and compare the effectiveness of prevention of short-term postoperative complications, which are manifested in the form of GERD, by performing preventive antireflux procedure in combination with restrictive bariatric surgery. Evaluation of the effectiveness and long-term effects of the presented restrictive operations was carried out on the basis of retrospective data obtained during the supervision of 46 patients with obesity and metabolic syndrome (men / women - 16/30, average age – 41.19±6.07, body weight – 128.26±7.37 kg, abdominal circumference – 133.4±4.71 cm, body mass index (BMI) – 42.66±2.41 kg/m2, I-III ASA). In the preoperative and postoperative periods, during consultations, in all patients measurements of anthropometric indicators were performed, laboratory data and results of instrumental research were considered. All metabolic procedures presented were performed at the basis of the Department of Surgery and Vascular Surgery of NMAPE named after P.L. Shupik in the period from 2016 to 2019. 13 patients underwent LSG, 20 – LGP and 13 - LFGP. In order to control the results, repeated consultations were carried out at 1, 3, 6 and 12 months of the postoperative period. The average duration of the operation was: LSG – 88.5±6.49 min, LGP - 120±5.42 min, LFGP – 135.38±7.48 min. The average period of hospitalization was: LSG – 3.2±0.63 days, LGP – 3.53±0.62 days, and LFGP – 3.5±0.67 days. After a year, the body mass index (BMI) was: LSG – 31.17±0.31 kg/m2, LGP – 32.48±0.23 kg/m2, LFGP – 32.43±0.21 kg/m2. According to the results of a repeated questioning of patients one year after the operation, 3 (23.07%) of the LSG group and 5 (25.0%) of the LGP group had symptoms of GERD, which failed to be eliminated with the help of conservative therapy, life quality of patients became significantly worse. In the group of patients who underwent LFGP, this complication was absent. After the control gastroscopy, 1 year after, de novo signs of reflux esophagitis were detected (according to the Los Angeles classification): in the LSG group – 3 (23.07%) patients (2 - grade A and 1 - grade B), in the LGP group – 5 (25.0%) patients (3 – grade A and 2 – grade B). Among patients who underwent LFGP, there were no signs of reflux esophagitis. Considering the possible development of GERD and reflux esophagitis in one year after the restrictive surgery, the use of preventive measures consisting in the simultaneous performance of antireflux and metabolic operations is relevant, this is demonstrated by the example of LFGP. We recommend to give preference to simultaneous operations for the achievement of not only high rates of weight loss, but also for improvement of the quality of patients` life in the future.
References
Anstey KJ, Cherbuin N, Budge M, Young J. (2011). Body mass index in midlife and late-life as a risk factor for dementia: a meta-analysis of prospective studies. Obesity Reviews, 12(5), e426–e437. doi: https://doi.org/10.1111/j.1467-789X.2010.00825.x
Carter PR, LeBlanc KA, Hausmann MG, Kleinpeter KP, deBarros SN, Jones SM. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2011;7(5):569–572. doi: https://doi.org/10.1016/j.soard.2011.01.040
Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J, Himpens J. Bariatric Surgery Worldwide: Baseline Demographic Description and One-Year Outcomes from the Fourth IFSO Global Registry Report 2018. Obesity Surgery. doi: https://doi.org/10.1007/s11695-018-3593-1
Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body Fatness and Cancer — Viewpoint of the IARC Working Group. New England Journal of Medicine. 2016;375(8):794-798. doi: https://doi.org/10.1056/NEJMsr1606602
Czernichow S, Kengne A-P, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk? Evidence from an individual-participant meta-analysis of 82 864 participants from nine cohort studies. Obesity Reviews. 2011;12(9):680-7 doi: https://doi.org/10.1111/j.1467-789X.2011.00879.x
Piotr Małczak, Magdalena Pisarska, Major Piotr, Michał Wysocki, Andrzej Budzyński, Michał Pędziwiatr. Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis. OBES SURG. 2017;27:226-235.
Volkan Yumuk, Constantine Tsigos, Martin Fried, et al. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8:402-424. doi: https://doi.org/10.1159/000442721
Braghetto I, Csendes A, Korn O, Valladares H, Gonzalez P, Henríquez A. Gastroesophageal Reflux Disease After Sleeve Gastrectomy. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2010;20(3):148–153. doi: https://doi.org/10.1097/SLE.0b013e3181e354bc
Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2015 (GBD 2015) Obesity and Overweight Prevalence 1980-2015. Seattle, United States: Institute for Health Metrics and Evaluation; 2017.
Kelly T, Yang W, Chen C-S, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. International Journal of Obesity. 2008;32(9):1431-7. doi: https://doi.org/10.1038/ijo.2008.102
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319-324 PMID: 20622654 doi: https://doi.org/10.1097/SLA.0b013e3181e90b31
Jennifer Peat, Belinda Barton. Medical Statistics: A Guide to Data Analysis and Critical Appraisal; 2005. doi: https://doi.org/10.1002/9780470755945
Chopra A, Chao E, Etkin Y, Merklinger L, Lieb J, Delany H. Laparoscopic sleeve gastrectomy for obesity: can it be considered a definitive procedure? Surgical Endoscopy. 2011;26(3):831–837. doi: https://doi.org/10.1007/s00464-011-1960-2
Arias E, Martínez PR, Ka Ming, Li V, Szomstein S, Rosenthal RJ. Mid-term Follow-up after Sleeve Gastrectomy as a Final Approach for Morbid Obesity. Obesity Surgery. 2009;19(5):544-8. doi: https://doi.org/10.1007/s11695-009-9818-6
Singh GM, Danaei G, Farzadfar F, Stevens GA, Woodward M, Wormser D. The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis. PLoS ONE. 2013;8(7):e65174. doi: https://doi.org/10.1371/journal.pone.0065174
Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L. The impact of obesity on the musculoskeletal system. International Journal of Obesity, 2007;32(2):211-22. doi: https://doi.org/10.1038/sj.ijo.0803715
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Medicni perspektivi (Medical perspectives)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.