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Ebrahimi SA, Mostafavian Z, Karazhian E, Najafi F, Mashoufi R, Zandbaf T, Mokhtari E. Validity and reliability of the Persian version of the Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire. BMJ Open Gastroenterol 2024; 11:e001298. [PMID: 38575328 PMCID: PMC11004686 DOI: 10.1136/bmjgast-2023-001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE The Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) is one of the most widely used questionnaires for assessing typical gastro-oesophageal reflux disease (GORD) symptoms. It is simple, concise, and treatment responsive, yet it has not been validated in the Persian language. This study aimed to translate the GERD-HRQL questionnaire into Persian and assess its validity and reliability. DESIGN In this cross-sectional validation study, a team of gastroenterologists, general surgeons, and professional translators conducted the forward-backward translation. A gastroenterologist interviewed 10 patients with GORD to insure understandability of the questionnaire. Fifty-four patients with GORD and 60 patients with gastrointestinal complaints other than GORD were enrolled using convenience sampling method. To assess concurrent validity, patients with GORD completed the Persian GERD-HRQL and the WHO Quality of Life Brief Version (WHOQOL-BREF) questionnaires. To assess discriminant validity, GERD-HRQL scores were compared between GORD and non-GORD patients. After 2 weeks, the patients with GORD completed the GERD-HRQL questionnaire again to assess test-retest reliability. The internal consistency was measured using Cronbach's alpha. RESULTS The mean age of the GORD participants was 36.90±10.44, and the majority were women (78%). All GERD-HRQL domains and total scores exhibited significant negative correlations with WHOQOL-BREF domains (ranging from -0.28 to -0.97). The GERD-HRQL scores were significantly different in GORD and non-GORD patients (p<0.001). Test and retest scores did not show any significant differences (p=0.49). Cronbach's alpha was 0.85. CONCLUSION The Persian GERD-HRQL questionnaire is valid and reliable and can effectively assess the GORD symptoms in Persian-speaking individuals.
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Affiliation(s)
| | - Zahra Mostafavian
- Department of Community Medicine, Islamic Azad University, Mashhad, Iran
| | - Elahe Karazhian
- Department of Medical-Surgical Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Rasam Mashoufi
- Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General Surgery, Islamic Azad University, Mashhad, Iran
| | - Elham Mokhtari
- Department of Internal Medicine, Islamic Azad University, Mashhad, Iran
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Alzahrani MA, Alamri FS, Alshahrani HM, Alshahrani AM, Mohammed AM, Saif RA, Alqarni SA, Godhaif NA, Al Mudawi AAM. Factors influencing the quality of life of GERD patients in the Aseer Region, Saudi Arabia. J Family Med Prim Care 2023; 12:3217-3221. [PMID: 38361855 PMCID: PMC10866214 DOI: 10.4103/jfmpc.jfmpc_620_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/20/2023] [Accepted: 07/31/2023] [Indexed: 02/17/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder characterized by troublesome symptoms, including heartburn and acid regurgitation. GERD is associated with complications such as peptic stricture, Barrett's esophagus, and esophageal adenocarcinoma, and it negatively affects quality of life (QoL). Aims To assess the factors influencing the QoL of GERD patients in the Aseer region of Saudi Arabia. Settings and Design This descriptive cross-sectional study used self-administered questionnaires in a study population of patients aged ≥18 years from Aseer, Saudi Arabia, between January 15, 2023-February 15, 2023. Materials and Methods A previously validated GERD health-related QoL (GERD-HRQoL) questionnaire was used to assess the patients' sociodemographic data, GERD, and GERD-HRQoL. Statistical Analysis Used Descriptive analysis included describing the frequency distribution and percentage for study variables, including demographic data, GERD-related QoL symptoms, and QoL, which were graphed. Cross-tabulation presented the distribution of GERD-HRQoL scores by their personal data and other factors using the Pearson Chi-square and exact probability tests. Results Overall, 502 participants previously diagnosed with GERD completed the questionnaire. Participants' were aged 18-65 years (mean age of 31.5 ± 14.6 years), and 384 (76.5%) were male. The most frequent symptom affecting QoL was heartburn (85.9%), followed by postprandial heartburn (84.3%), heartburn while lying down (82.7%), bloating or gassy feelings (79.9%), and heartburn while standing up (77.3%). Conclusions Our study showed that patients with GERD had a poor QoL due to GERD-related symptoms, mainly heartburn. Younger age, male sex, and lower educational status were associated with lower GERD-HRQoL scores.
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Affiliation(s)
| | - Faisal S. Alamri
- Department of Internal Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Ali M. Alshahrani
- Department of Internal Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ali M. Mohammed
- Department of Internal Medicine, King Khalid University, Abha, Saudi Arabia
| | - Rayan A. Saif
- Department of Internal Medicine, King Khalid University, Abha, Saudi Arabia
| | - Saeed A. Alqarni
- Department of Internal Medicine, King Khalid University, Abha, Saudi Arabia
| | - Naif A. Godhaif
- Department of Internal Medicine, King Khalid University, Abha, Saudi Arabia
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Ortenzi M, Guerrieri M, Saraceno F, Reggiani A, Lepiane P, Sileri P, Balla A. Prospective Italian validation of the Vaizey and Wexner and fecal incontinence severity index (FISI) questionnaires. Updates Surg 2023; 75:1617-1623. [PMID: 37368229 DOI: 10.1007/s13304-023-01567-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023]
Abstract
Several objective severity measurement questionnaires of the fecal incontinence (FI), are available to describe type, frequency and degree of FI, and their impact on quality of life, aiming to establish baseline scores measure response to treatment over time and allow comparison among patients treated using different strategies. Presently, despite their widespread use in clinical practice, none of these questionnaire have been validated in the Italian language. The aim is to test the translated Italian version of the Vaizey and Wexner and Fecal Incontinence Severity Index (FISI) questionnaires assessing their reliability and validity among Italian-speaking patients. Two researchers proficient in spoken English and Italian translated both questionnaires in the Italian language. They independently translated the two questionnaires from English and then they met to produce a single version of the two questionnaires, to solve any possible discrepancy. A forward-backward translation was then obtained by a professional bilingual translator, so as to define the final version of the questionnaires. The questionnaires were independently administered twice to 100 Italian-speaking patients by two different and independent raters. Cronbach's α of the first and second Vaizey and Wexner questionnaire was 0.755 and 0.727, respectively. While Cronbach's α of the first and second FISI questionnaire was 0.810 and 0.806, respectively. Spearman correlation and inter-rater reliability were 0.937 and 0.913 for Vaizey and Wexner questionnaire, respectively, and 0.915 and 0.871 for FISI questionnaire, respectively. Italian version of the Vaizey and Wexner and FISI questionnaires proved good consistency, reliability, reproducibility, showing good psychometric properties.
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Affiliation(s)
- Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Mario Guerrieri
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Federica Saraceno
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
| | - Angelica Reggiani
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Pasquale Lepiane
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy
| | - Pierpaolo Sileri
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Balla
- UOC of General and Minimally Invasive Surgery, Hospital "San Paolo", Largo Donatori del Sangue 1, Civitavecchia, 00053, Rome, Italy.
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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25 Years of the GERD-HRQL symptom severity instrument: an assessment of published applications. Surg Endosc 2023; 37:255-265. [PMID: 35920907 DOI: 10.1007/s00464-022-09463-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/11/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The GERD-HRQL symptom severity instrument was developed and published 25 years ago. This seems like an apropos time to review how the instrument has been used in the "real-world." METHODS Google Scholar, PubMed, and Web of Science websites search was done using the keywords "GERD-HRQL" or its author, "Velanovich." Once articles were identified, the following information was obtained from each article: first author name, country of origin, journal published, year of publications, type of study design, subject of study, category of study, disease type studied, purpose of the study, how the GERD-HRQL scores were reported, how the GERD-HRQL scores were statistically reported, and results of the study. The total and change of scores were analyzed for descriptive statistics based on disease process studied and intervention studied. RESULTS A total of 767 articles by 562 different first authors were identified in 193 different journals from 53 different countries of study origin. After a period of steady usages, the number of publication employing the GERD-HRQL has rapidly increase over the last 5 years. There have been 8 validated translations into other languages, although there appears to be numerous, non-validated ad hoc translations. Most commonly used or studied: observational cohort study design, surgical treatment study category, GERD disease process, treatment effect study purpose, total GERD-HRQL scores reported as means or medians. However, there were a wide variety of other study designs, study categories, disease processes, and study purposes. In general, GERD and laryngopharyngeal reflux had the high pre-treatment scores (i.e., more severe symptoms), and surgical and endoscopic interventions the lowest post-treatment score (i.e., least severe symptoms) with the largest change in score (i.e., treatment impact. CONCLUSIONS The GERD-HRQL has proven to be a reliable, responsive and versatile symptom severity instrument for studies involving GERD as a subject.
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Muacevic A, Adler JR, Alghamdi H, S. AlOtaibi A, Alshareef K, Alzahrani KM. Quality of Life and Body Mass Index Changes Three Years After Laparoscopic Sleeve Gastrectomy in Taif City, Saudi Arabia. Cureus 2022; 14:e32754. [PMID: 36686102 PMCID: PMC9851730 DOI: 10.7759/cureus.32754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background Obesity has become a major global health challenge, and its prevalence has tripled in the last four decades. Impaired quality of life (QoL) is a strong incentive for severely obese patients to seek help. Sleeve gastrectomy (SG) is the most frequently practiced bariatric procedure worldwide. This study aimed to investigate the QoL and changes in body weight three years post laparoscopic SG. Methods A cross-sectional, observational study was performed in outpatient clinics in Taif city, Saudi Arabia. The study included 147 adult patients who underwent SG at least three years before inclusion in the study. Data were collected using a questionnaire designed based on the validated Bariatric quality of life (BQL) and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQoL) surveys. Results All patients were suffering from class I, class II, or class III obesity before undergoing SG. Three years post-surgery, 72.8% reached their normal weight or were overweight (P<0.001). The mean± SD BMI (45± 7.0 kg/m2) significantly decreased to 26.8± 4.6 kg/m2 (P<0.001). Most of the participants (78.2%) achieved an excess weight loss percent (EWL%) of 75% or more. The mean± SD BQL score was 45.5± 5.2 points and the median (IQR) GERD-HRQoL score was 7 (15). Higher EWL% was significantly associated with a higher BQL score (P=0.041). Conclusions The current study revealed a better quality of life among patients experiencing higher rates of excess weight loss percent (EWL%) after three years of sleeve gastrectomy as compared to other patients.
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An Improved Endoscopic Automatic Classification Model for Gastroesophageal Reflux Disease Using Deep Learning Integrated Machine Learning. Diagnostics (Basel) 2022; 12:diagnostics12112827. [PMID: 36428887 PMCID: PMC9689126 DOI: 10.3390/diagnostics12112827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/05/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common digestive tract disease, and most physicians use the Los Angeles classification and diagnose the severity of the disease to provide appropriate treatment. With the advancement of artificial intelligence, deep learning models have been used successfully to help physicians with clinical diagnosis. This study combines deep learning and machine learning techniques and proposes a two-stage process for endoscopic classification in GERD, including transfer learning techniques applied to the target dataset to extract more precise image features and machine learning algorithms to build the best classification model. The experimental results demonstrate that the performance of the GerdNet-RF model proposed in this work is better than that of previous studies. Test accuracy can be improved from 78.8% ± 8.5% to 92.5% ± 2.1%. By enhancing the automated diagnostic capabilities of AI models, patient health care will be more assured.
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Balla A, Corallino D, Quaresima S, Palmieri L, Meoli F, Cordova Herencia I, Paganini AM. Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study. Front Surg 2022; 9:906133. [PMID: 35693301 PMCID: PMC9178117 DOI: 10.3389/fsurg.2022.906133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/11/2022] [Indexed: 01/17/2023] Open
Abstract
Aims Indocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate. Methods Thirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2–58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures. Results Fom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case. Conclusions ICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.
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Chmielik LP, Mielnik-Niedzielska G, Kasprzyk A, Niedzielski A. A review of health-related quality of life issues in children suffering from certain key otolaryngological illnesses. Front Pediatr 2022; 10:1077198. [PMID: 36714651 PMCID: PMC9875050 DOI: 10.3389/fped.2022.1077198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The health-related quality of life (HRQoL) concept is nowadays increasingly and more broadly used for helping evaluate the effectiveness of medical treatment, superseding the earlier "quality of life" approach. The HRQoL concept likewise applies to otolaryngology and this narrative review study is focused on HRQoL outcomes in four key childhood otolaryngological diseases as reported in the literature. STUDY AIM To retrospectively evaluate the literature on measuring HRQoL in children suffering from selected otolaryngological illnesses, during treatment. MATERIALS AND METHODS Published studies/case reports were searched for in Medline, PubMed, Web of Science, Scopus and ORCID on the quality of life based on paediatric patient questionnaires, whether completed by subjects themselves or by their parents (by proxy). The following key words were used: health quality of life, otolaryngology/ENT, pediatrics/paediatrics. Studies before 1999 were omitted because hitherto, the "quality of life" had been imprecisely defined thus rendering any subsequent comparisions problematic. RESULTS HRQoL scores and well-being were found to significantly deteriorate in child patients suffering from four important otolaryngological disorders: chronic sinusitis, nasal septum deviation, adenoid hypertrophy and hearing disease. The main problems found were infection, inflammation, disruption to family life and child-parental interaction, fitness-related issues, reduced ENT patencies and apnea. CONCLUSIONS The HRQoL appears to significantly deteriorate in children suffering from otolaryngological diseases. Further such studies are needed for other ENT diseases.
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Affiliation(s)
- Lechosław Paweł Chmielik
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Pediatric ENT, The Children's Hospital in Dziekanów Leśny, Dziekanów Leśny, Poland
| | | | - Anna Kasprzyk
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Pediatric ENT, The Children's Hospital in Dziekanów Leśny, Dziekanów Leśny, Poland
| | - Artur Niedzielski
- Department of Pediatric Otolaryngology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Department of Pediatric ENT, The Children's Hospital in Dziekanów Leśny, Dziekanów Leśny, Poland
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Balla A, Palmieri L, Corallino D, Meoli F, Carlotta Sacchi M, Ribichini E, Pronio A, Badiali D, Paganini AM. Does Sleeve Gastrectomy Worsen Gastroesophageal Reflux Disease in Obese Patients? A Prospective Study. Surg Innov 2021; 29:579-589. [PMID: 34865557 DOI: 10.1177/15533506211052745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LGB) on gastroesophageal reflux disease (GERD). METHODS GERD was evaluated by the Modified Italian Gastroesophageal reflux disease-Health-Related Quality of Life (MI-GERD-HRQL) questionnaire, pH-manometry, endoscopy, and Rx-esophagogram, before and 12 months after surgery. Based on these exams, patients without GERD underwent LSG, and patients with GERD underwent LGB. RESULTS Thirteen and six patients underwent LSG and LGB, respectively. After LSG, the only statistically significant difference observed at pH-manometry was the median DeMeester score, from 5.7 to 22.7 (P = .0026). De novo GERD occurred in 6 patients (46.2%), with erosive esophagitis in one. The median MI-GERD-HRQL score improved from 3 to 0. Overall, nine patients underwent LGB, but three were lost to follow-up. Preoperative pH-manometry changed the surgical indication from LSG to LGB in 7 out of 9 patients (77.8%). Six patients who underwent LGB completed the study, and at pH-manometry, statistically significant differences were observed in the percentage of total acid exposure time, with the number of reflux episodes lasting >5 minutes and DeMeester score (P = .009). The median MI-GERD-HRQL score improved from 6.5 to 0. Statistically significant differences were not observed at endoscopy and Rx-esophagogram findings in both groups. CONCLUSIONS LSG has a negative impact on GERD, even in patients without preoperative GERD. LGB confirmed to be the intervention of choice in patients with GERD. Preoperative pH-manometry may identify patients with silent GERD, to candidate them to LGB rather than LSG. pH-manometry should be used more liberally to establish the correct surgical indication on objective grounds.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Livia Palmieri
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Diletta Corallino
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Francesca Meoli
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Maria Carlotta Sacchi
- Department of Translational and Precision Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Emanuela Ribichini
- Department of Translational and Precision Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Annamaria Pronio
- Digestive Endoscopy Unit, Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
| | - Danilo Badiali
- Department of Translational and Precision Medicine, 9311Sapienza University of Rome, Rome, Italy
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", 9311Sapienza University of Rome, Rome, Italy
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de Angelis F, Boru CE, Iossa A, Perotta N, Campanile FC, Silecchia G. Long-term outcomes of sleeve gastrectomy as a revisional procedure after failed gastric band: a multicenter cross-matched cohort study. Updates Surg 2021; 74:709-713. [PMID: 34604938 PMCID: PMC8995258 DOI: 10.1007/s13304-021-01182-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/22/2021] [Indexed: 11/27/2022]
Abstract
Laparoscopic adjustable gastric band (LAGB) is the bariatric procedure most likely subject to revisional surgery. Both laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) represent viable options, but the long-term results are still lacking. In 2014, we published the 2-year follow-up of our multicenter cohort of revisional LSG after failed LAGB. Evaluate the long-term follow-up (median 9.3 years) of the same cohort of patients. University and primary-care hospitals, Italy. We retrospectively examined a prospectively maintained database of the previously published multicenter cohort of 56 patients who underwent LSG after failed LAGB between 2008-2011. The control group included cross-matched non-revisional LSGs. The primary endpoint was weight loss, secondary endpoints co-morbidities, and the need for further bariatric surgery. The study group included 44 patients and the control group 56. We found %EWL 53% Vs. 67% (p = .021), %EBMIL (54 Vs. 68%, p = .018), %TWL (26 Vs. 34%, p = .002). We also found more severe GERD (gastroesophageal reflux disease) symptoms in the revisional than in the primary group (9.0 vs. 1.8% mild and 23.0 vs. 3.0% severe). Ten patients from the revisional group (22.7%) vs. eight in the primary group (13%) underwent further bariatric surgery (LRYGB). Our results showed less favorable weight loss in revisional than primary LSG after LABG, higher prevalence of GERD, and a more frequent need for further revisional surgery. Despite the study's limitations, the present data suggest that the long-term outcomes may offset the possible reduced short-term complication rate after revisional sleeve gastrectomy for a failed LABG.
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Affiliation(s)
- Francesco de Angelis
- Division of General Surgery & Bariatric Center of Excellence IFSO-EC, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Corso Della Repubblica, 78, 04100 Latina, Italy
| | - Cristian Eugeniu Boru
- Division of General Surgery & Bariatric Center of Excellence IFSO-EC, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Corso Della Repubblica, 78, 04100 Latina, Italy
| | - Angelo Iossa
- Division of General Surgery & Bariatric Center of Excellence IFSO-EC, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Corso Della Repubblica, 78, 04100 Latina, Italy
| | - Nicola Perotta
- Department of General Surgery, “San Pio da Pietralcina” Hospital, Villa D’Agri, Italy
| | | | - Gianfranco Silecchia
- Division of General Surgery & Bariatric Center of Excellence IFSO-EC, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Corso Della Repubblica, 78, 04100 Latina, Italy
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Rengo M, Boru CE, Badia S, Iossa A, Bellini D, Picchia S, Panvini N, Carbone I, Silecchia G, Laghi A. Preoperative measurement of the hiatal surface with MDCT: impact on surgical planning. Radiol Med 2021; 126:1508-1517. [PMID: 34449001 PMCID: PMC8702505 DOI: 10.1007/s11547-021-01413-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/13/2021] [Indexed: 01/01/2023]
Abstract
Objective To evaluate the accuracy and reproducibility of hiatal surface area (HSA) measurement on dedicated multidetector computed tomography (MDCT) acquisition, in patients, previously subjected to laparoscopic sleeve gastrectomy (LSG), and affected by gastroesophageal reflux disease (GERD). Intraoperative HSA measurement was considered the reference standard.
Methods Fifty-two candidates for laparoscopic hiatal hernia repair were prospectively included in the study. MDCT images were acquired during swallowing of oral iodinated contrast media and during strain. Measurements were performed by nine readers divided into three groups according to their experience. Results were compared with intraoperative measurements by means of Spearman correlation coefficient. Reproducibility was evaluated with intra- and interreader agreement by means of weighted Cohen’s kappa and intraclass correlation coefficient (ICC).
Results Significant differences between MDCT and intraoperative HSA measurements were observed for swallowing imaging for less experienced readers (p = 0.037, 0.025, 0.028 and 0.019). No other statistically significant differences were observed (p > 0.05). The correlation between HSA measured intraoperatively and on MDCT was higher for strain imaging compared to swallowing (r = 0.94—0.92 vs 0.94—0.89). The overall reproducibility of MDCT HSA measurement was excellent (ICC of 0.95; 95% CI 0,8993 to 0,9840) independently of reader’s experience Conclusion HSA can be accurately measured on MDCT images. This method is reproducible and minimally influenced by reader experience. The preoperative measurement of HSA has potential advantages for surgeons in terms of correct approach to hiatal defects in obese patient.
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Affiliation(s)
- Marco Rengo
- Department of Medico-Surgical Sciences and Biotechnologies, Diagnostic Imaging Unit, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy.
| | - Cristian E Boru
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence IFSO-EC, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Stefano Badia
- Department of Medico-Surgical Sciences and Biotechnologies, Diagnostic Imaging Unit, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence IFSO-EC, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Davide Bellini
- Department of Medico-Surgical Sciences and Biotechnologies, Diagnostic Imaging Unit, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Simona Picchia
- Department of Medico-Surgical Sciences and Biotechnologies, Diagnostic Imaging Unit, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Nicola Panvini
- Department of Medico-Surgical Sciences and Biotechnologies, Diagnostic Imaging Unit, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Diagnostic Imaging Unit, "Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Centre of Excellence IFSO-EC, Sapienza" University of Rome, ICOT Hospital, Via Franco Faggiana, 1668. 04100, Latina, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Diagnostic Imaging Unit, "Sapienza" University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035. 00189, Rome, Italy
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