mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2023-66-74mossj-716Research ArticleСтатьиПроблема гастроэзофагеальной рефлюксной болезни в исходе продольной резекции желудка и варианты ее решенияSuccessfully treat post-sleeve gastrectomy GERD, the cause of the problem must first be identifiedhttps://orcid.org/0000-0001-8708-9455ЦепковскийА. С.TsepkovskyA. S.

Цепковский Александр Сергеевич

107392,г. Москва, ул. Малая Черкизовская, 7

Tsepkovsky Alexander Sergeevich

Moscow, M.Cherkizovskaia 7, 107392

CAS_82@mail.ruhttps://orcid.org/0000-0002-2904-0730ЛевчукА. Л.LevchukA. L.

Левчук Александр Львович – доктор медицинских наук, профессор, советник по хирургическим вопросам

105203, Россия, г. Москва, ул. Нижняя Первомайская, д. 70

 

Alexandr Lvovich Levchuk – MD, PhD, Director’s Advisor 

105203, Nizhnyaia Pervomaiskaia 70, Moscow

talisman157@yandex.ruhttps://orcid.org/0000-0001-6943-9757БалеевМ. С.BaleevM. S.

Балеев Михаил Сергеевич – к.м.н., врач-хирург хирургического отделения 

603157, Нижний Новгород, ул. Березовская 85 А

Baleev Mikhail Sergeevich – PhD, Surgeon of the Surgical Departmen

Nizhny Novgorod, st. Berezovskaya 85 A, 603157

baleev_ms@mail.ruФГБ ВОУ ВО Военно-медицинская академия им. С.М. Кирова (филиал г. Москва)РоссияS.M. Kirov Military Medical Academy (Moscow branch)Russian FederationФГБ ВОУ ВО Военно-медицинская академия им. С.М. Кирова (филиал г. Москва); ФГБУ «Национальный медико-хирургический Центр им. Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияS.M. Kirov Military Medical Academy (Moscow branch); N. I. Pirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница № 30 Московского района, города Нижнего НовгородаРоссияClinical Hospital № 30 of Nizhny NovgorodRussian Federation20233110202300Сентябрь. Спецвыпуск6674Copyright © Цепковский А.С., Левчук А.Л., Балеев М.С., 20232023Цепковский А.С., Левчук А.Л., Балеев М.С.Tsepkovsky A.S., Levchuk A.L., Baleev M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/716Введение

Введение. Продольная резекция желудка (ПРЖ) самая часто выполняемая в мире бариатрическая операция, а гастроэзофагеальная рефлюксная болезнь (ГЭРБ) является наиболее частым ее осложнением. Несмотря на многообразие причин данного осложнения, гастрошунтирование зачастую становится безальтернативным вариантом его лечения.

Цель исследования

Цель исследования. Проанализировать факторы развития ГЭРБ после ПРЖ и варианты хирургической тактики ее лечения, предложить алгоритм хирургического лечения ГЭРБ в зависимости от причины её развития.

Материал и методы

Материал и методы. Проведен поиск и анализ литературы в базе данных Medline (pubmed.org), оценивающих послеоперационные результаты первичной операции ПРЖ. В рассмотрение включались метаанализы, рандомизированные и нерандомизированные исследования; ключевыми словами в поиске являлись: продольная резекция желудка, гастроэзофагеальная рефлюксная болезнь, грыжа пищеводного отверстия диафрагмы, желудочное шунтирование. Проведен обзор методов хирургического лечения ГЭРБ в зависимости от этиологических факторов.

Результаты

Результаты. Повышенное внутрижелудочное давление, нарушение моторики пищевода, дистония нижнего пищеводного сфинктера, грыжа пищеводного отверстия диафрагмы и форма слива являются основными факторами развития ГЭРБ после ПРЖ. Универсального способа хирургического лечения ГЭРБ после ПРЖ, обладающего абсолютной эффективностью, не существует. Подход к решению проблемы ГЭРБ должен быть дифференцированным, то есть учитывать факторы ее развития. Уменьшению симптомов может способствовать устранение грыжи пищеводного отверстия диафрагмы или деформации желудка, например, стриктуры и дилатации. При дисфункции нижнего пищеводного сфинктера, стоит рассмотреть варианты гастрошунтирования, наиболее эффективным из которых является RYGB. 

Introduction

Introduction. Sleeve gastrectomy (SG) is the most frequently performed bariatric surgery in the world. Gastroesophageal reflux disease (GERD) is most common post-SG complication. Post-SG patients with GERD refractory to proton pump inhibitors usually undergo anatomy-altering Roux-en-Y gastric bypass surgery which becomes the only treatment as usual.

Purpose

Purpose: to analyze the factors for the development of GERD after SG and the surgical options for treatment. To propose an algorithm for the surgical treatment of GERD, depending on the cause of its development.

Materials and methods

Materials and methods. A search and analysis of the literature in the Medline database (pubmed.org) evaluating the postoperative results of primary SG surgery was carried out. The review included meta-analyses, randomized and non-randomized trials. Key words in the search were: sleeve gastrectomy, gastroesophageal reflux disease, hiatal hernia, gastric bypass. A review of the methods of surgical treatment of GERD, depending on the etiological factors, was carried out.

Conclusion

Conclusion. Increased intragastric pressure, esophageal dysmotility, lower esophageal sphincter dystonia, concomitant hiatal hernia and the shape of the sleeve are major GERD factors. There is no universal method of surgical treatment GERD after SG, which has absolute effectiveness. The approach to solving the problem of GERD should be differentiated, that is, take into account the factors of its development. Repairing a hiatal hernia or gastric deformities such as strictures and dilations may help improve symptoms. With dysfunction of the lower esophageal sphincter, gastric bypass options should be considered, the most effective of which is RYGB.

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The authors declare that there are no conflicts of interest present.