Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass.
Concurrent hiatal hernia repair and bariatric surgery: outcomes after sleeve gastrectomy and Roux-en-Y gastric bypass.
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DOI：
10.1016/j.soard.2020.08.035
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Wharam JF
中科院分区：
文献类型：
--
作者：
Lewis KH;Callaway K;Argetsinger S;Wallace J;Arterburn DE;Zhang F;Fernandez A;Ross-Degnan D;Dimick JB;Wharam JF
裂孔疝通常与减肥手术同时修复，以降低胃食管反流疾病相关并发症的风险。目的：探讨并发裂孔疝修补术（HHR）与减肥结果之间的关系。背景：2010-2017年美国商业保险理赔数据集。我们进行了一项回顾性队列研究。我们确定了单独接受袖胃切除术（SG）或Roux-en-Y胃旁路术（RYGB）或同时接受HHR的减肥手术的成年人。我们将患有和不患有HHR的患者进行了匹配，并对患者进行了长达3年的腹部手术干预、体重矫正/转换和内窥镜检查。使用多变量Cox比例风险模型比较每个结果发生第一事件的时间。我们将1546例有HHR的SG患者与3170例无HHR的SG患者进行了配对，将457例有HHR的RYGB患者与1156例无HHR的RYGB患者进行了配对。73%的患者术后随访一年。同时接受SG和HHR的患者更有可能在术后1年内进行额外的腹部手术（校正风险比[aHR]， 2.1; 95% CI, 1.5 - 3.1）和内窥镜检查（aHR, 1.5; 95% CI, 1.2-1.8），但不进行体重矫正/转换（aHR, 1.7; 95% CI, 0.6 - 4.6），这一模式在随访3年时保持不变。在RYGB患者中，并发HHR仅与1年随访时内窥镜检查风险增加相关（aHR, 1.4; 95% CI, 1.1-1.8），并持续3年。并发的SG/HHR与一些后续手术和非手术干预的风险增加有关，这种模式在RYGB中没有一致观察到。其他的研究可以检查并发HHR技术的改变是否可以降低风险。
Hiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications. To examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes. Setting: A 2010–2017 U.S. commercial insurance claims data set. We conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling. We matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5–3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2–1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6–4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1–1.8)) at 1 year of follow-up, persisting at 3 years. Concurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk.
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影响因子：
13.8
作者：
Lewis, Kristina H.;Arterburn, David E.;Wharam, James F.
通讯作者：
Wharam, James F.
影响因子：
2.9
作者：
Melissas, John;Stavroulakis, Konstantinos;Kabir, Ali
通讯作者：
Kabir, Ali
影响因子：
2.9
作者：
Gagner, Michel;Deitel, Mervyn;Crosby, Ross D.
通讯作者：
Crosby, Ross D.
影响因子：
3.2
作者：
Obeid, Tammam;Krishnan, Aravind;Steele, Kimberley E.
通讯作者：
Steele, Kimberley E.
DOI：
10.1016/j.jamcollsurg.2015.01.059
发表时间：
2015-05-01
影响因子：
5.2
作者：
Young, Monica T.;Gebhart, Alana;Nguyen, Ninh T.
通讯作者：
Nguyen, Ninh T.