Pascale Karila-Cohen1, Anne-Laure Pelletier2, Loukbi Saker1, Cédric Laouénan3,4,5, Delphine Bachelet4,5, Antoine Khalil1, Konstantinos Arapis6. 1. Department of Radiology, Bichat-Claude Bernard University Hospital, Paris, France. 2. Department of Hepato-Gastro-Enterology, Bichat-Claude Bernard University Hospital, Paris, France. 3. UMR 1137, Université de Paris, INSERM, Paris, France. 4. INSERM, Centre d'Investigation clinique - Epidémiologie Clinique 1425, Hôpital Bichat, Paris, France. 5. Department of Epidemiology Biostatistics and Clinical Research, Hôpital Bichat, AP-HP, Paris, France. 6. Department of Digestive, Bariatric and Endocrinal Surgery, Avicenne University Hospital, 125 route de Stalingrand, 93000 CEDEX, Bobigny, Paris, France. konstarapis@hotmail.com.
Abstract
PURPOSE: Migration of the staple line is the definition of sliding hiatus hernia in sleeve gastrectomy patients. The main aim was to determine the frequency and measurement of intrathoracic staple line migration and its correlation with GERD symptoms and pH monitoring. MATERIALS AND METHODS: This was a prospective clinical trial including all patients who underwent sleeve gastrectomy more than 1 year previously. All the patients underwent computed tomography (CT) imaging, and migration of the proximal end of the suture above the level of the hiatus was measured in mm. All the patients with symptoms suggestive of GERD were assessed using the GERD impact scale (GIS), and wireless 24-h esophageal pH and symptom association monitoring (SAP) were carried out. Analysis of risk factors for postoperative staple line migration was performed. RESULTS: Between March 2018 and December 2018, 194 patients were evaluated (mean age 45.1 ± 11.2 years; 161 females); 88/194 (45.4%) presented an average intrathoracic migration of 16.2 ± 6.9 mm. Thirty-eight of 194 (19.5%) patients presented symptoms suggestive of gastroesophageal reflux. There was a significant relationship between staple line intrathoracic migration and postsleeve GERD symptomatology (p = 0.0004, OR = 4.25 [1.92-9.39]). However, there was no significant correlation between positive 24-h pH monitoring and intrathoracic migration of the staple line (p = 0.1). CONCLUSION: A migration greater than 17 mm was strongly correlated with postsleeve GERD symptoms but not with positive 24-h pH monitoring.
PURPOSE: Migration of the staple line is the definition of sliding hiatus hernia in sleeve gastrectomy patients. The main aim was to determine the frequency and measurement of intrathoracic staple line migration and its correlation with GERD symptoms and pH monitoring. MATERIALS AND METHODS: This was a prospective clinical trial including all patients who underwent sleeve gastrectomy more than 1 year previously. All the patients underwent computed tomography (CT) imaging, and migration of the proximal end of the suture above the level of the hiatus was measured in mm. All the patients with symptoms suggestive of GERD were assessed using the GERD impact scale (GIS), and wireless 24-h esophageal pH and symptom association monitoring (SAP) were carried out. Analysis of risk factors for postoperative staple line migration was performed. RESULTS: Between March 2018 and December 2018, 194 patients were evaluated (mean age 45.1 ± 11.2 years; 161 females); 88/194 (45.4%) presented an average intrathoracic migration of 16.2 ± 6.9 mm. Thirty-eight of 194 (19.5%) patients presented symptoms suggestive of gastroesophageal reflux. There was a significant relationship between staple line intrathoracic migration and postsleeve GERD symptomatology (p = 0.0004, OR = 4.25 [1.92-9.39]). However, there was no significant correlation between positive 24-h pH monitoring and intrathoracic migration of the staple line (p = 0.1). CONCLUSION: A migration greater than 17 mm was strongly correlated with postsleeve GERD symptoms but not with positive 24-h pH monitoring.
Authors: Jan S Burgerhart; Paul C van de Meeberg; Peter D Siersema; André J P M Smout Journal: Eur J Gastroenterol Hepatol Date: 2014-01 Impact factor: 2.566
Authors: Romano Schneider; Ioannis Lazaridis; Marko Kraljević; Christoph Beglinger; Bettina Wölnerhanssen; Ralph Peterli Journal: Surg Obes Relat Dis Date: 2018-01-12 Impact factor: 4.734