Purpose: Only anecdotally reported, intrathoracic migration (ITM) represents an unacknowledged complication after sleeve gastrectomy (LSG) contributing to gastroesophageal reflux disease (GERD) development, both recurrent and de novo. The primary endpoint of this study was to evaluate the incidence of postoperative ITM ≥ 2 cm; the secondary endpoint was to determine the relationships between ITM, GERD, endoscopic findings, and percentage of patients requiring surgical revision. Materials and Methods: A retrospective, multicenter study on prospective databases was conducted, analyzing LSGs performed between 2013 and 2018. Inclusion criteria consisted of primary operation; BMI ranging 35–60 kg/m2; age 18–65 years; minimum follow-up 24 months; and postoperative UGIE, excluding concomitant hiatal hernia repair. Esophageal manometry and 24-h pH-metry were indicated, based on postoperative questionnaires and UGIE; patients with GERD due to ITM, and non-responders to medical therapy, were converted to R-en-Y gastric bypass (RYGB). Results: An ITM ≥ 2cm was postoperatively diagnosed in 94 patients (7% of 1337 LSGs), after mean 24.16 ± 13.6 months. Postoperative esophagitis was found in 29 patients vs. 15 initially (p=0.001), while GERD was demonstrated in 75 (vs. 20 preoperatively, p< 0.001). Fifteen patients (16%) underwent revision to RYGB with posterior cruroplasty. Seventeen patients with severe GERD presented improvement of endoscopic findings and clinical symptoms as a result of conservative therapy. Conclusions: ITM after LSG is not a negligible complication and represents an important pathogenic factor in the development or worsening of GERD. Postoperative UGIE plays a fundamental role in the diagnosis of esophageal mucosal lesions.

Transhiatal migration after laparoscopic sleeve gastrectomy. Myth or reality? A multicenter, retrospective study on the incidence and clinical impact / Termine, Pietro; Boru, Eugeniu Cristian; Iossa, Angelo; Ciccioriccio, M. C.; Campanelli, M.; Bianciardi, E.; Gentileschi, P.; Silecchia, G.. - In: OBESITY SURGERY. - ISSN 0960-8923. - 31:8(2021), pp. 3419-3426. [10.1007/s11695-021-05340-x]

Transhiatal migration after laparoscopic sleeve gastrectomy. Myth or reality? A multicenter, retrospective study on the incidence and clinical impact

Termine Pietro;Boru Cristian Eugeniu
Project Administration
;
Iossa Angelo
Membro del Collaboration Group
;
Ciccioriccio M. C.
Membro del Collaboration Group
;
Silecchia G.
Supervision
2021

Abstract

Purpose: Only anecdotally reported, intrathoracic migration (ITM) represents an unacknowledged complication after sleeve gastrectomy (LSG) contributing to gastroesophageal reflux disease (GERD) development, both recurrent and de novo. The primary endpoint of this study was to evaluate the incidence of postoperative ITM ≥ 2 cm; the secondary endpoint was to determine the relationships between ITM, GERD, endoscopic findings, and percentage of patients requiring surgical revision. Materials and Methods: A retrospective, multicenter study on prospective databases was conducted, analyzing LSGs performed between 2013 and 2018. Inclusion criteria consisted of primary operation; BMI ranging 35–60 kg/m2; age 18–65 years; minimum follow-up 24 months; and postoperative UGIE, excluding concomitant hiatal hernia repair. Esophageal manometry and 24-h pH-metry were indicated, based on postoperative questionnaires and UGIE; patients with GERD due to ITM, and non-responders to medical therapy, were converted to R-en-Y gastric bypass (RYGB). Results: An ITM ≥ 2cm was postoperatively diagnosed in 94 patients (7% of 1337 LSGs), after mean 24.16 ± 13.6 months. Postoperative esophagitis was found in 29 patients vs. 15 initially (p=0.001), while GERD was demonstrated in 75 (vs. 20 preoperatively, p< 0.001). Fifteen patients (16%) underwent revision to RYGB with posterior cruroplasty. Seventeen patients with severe GERD presented improvement of endoscopic findings and clinical symptoms as a result of conservative therapy. Conclusions: ITM after LSG is not a negligible complication and represents an important pathogenic factor in the development or worsening of GERD. Postoperative UGIE plays a fundamental role in the diagnosis of esophageal mucosal lesions.
2021
endoscopic findings; GERD; intrathoracic sleeve migration; revisional surgery; sleeve gastrectomy
01 Pubblicazione su rivista::01a Articolo in rivista
Transhiatal migration after laparoscopic sleeve gastrectomy. Myth or reality? A multicenter, retrospective study on the incidence and clinical impact / Termine, Pietro; Boru, Eugeniu Cristian; Iossa, Angelo; Ciccioriccio, M. C.; Campanelli, M.; Bianciardi, E.; Gentileschi, P.; Silecchia, G.. - In: OBESITY SURGERY. - ISSN 0960-8923. - 31:8(2021), pp. 3419-3426. [10.1007/s11695-021-05340-x]
File allegati a questo prodotto
File Dimensione Formato  
Termine_Transhiatal-migration _2021.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 2.05 MB
Formato Adobe PDF
2.05 MB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1548407
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 12
  • ???jsp.display-item.citation.isi??? 9
social impact