关键词: 胃袖状切除术, 胃食管反流病, 食管裂孔疝, 胃胸腔上移

Abstract: Sleeve gastrectomy is currently the most commonly performed metabolic and bariatric surgery. However, postoperative gastroesophageal reflux disease is a common complication. Intra-thoracic sleeve migration is the main cause of refractory gastroesophageal reflux. The mechanism of its occurrence is influenced by multiple factors. The diagnosis depends on typical symptoms and results from upper gastrointestinal imaging series, endoscopy, etc. Esophageal pH monitoring and manometry are the key standards in the diagnosis of gastroesophageal reflux disease, while the confirmatory diagnosis of intra-thoracic sleeve migration is upper abdominal computed tomography (CT) plus three-dimensional reconstruction technique. Accurate preoperative diagnosis of hiatal hernia, precise intraoperative repair of hiatal hernia, postoperative adherence to correct dietary habits, and avoidance of excessive muscle loss are crucial for the prevention of gastroesophageal reflux disease and intra-thoracic sleeve migration. Initial treatment for postoperative gastroesophageal reflux disease can be conservative. If it severely affects the patient’s daily life, corrective surgery for gastroesophageal reflux disease may be considered. However, in cases of intra-thoracic sleeve migration, corrective surgery is typically required. The current correct approaches for corrective surgery currently include the repositioning of the stomach, the repair of the hiatal hernia, and the modification of the sleeve gastrectomy to a standard Roux-en-Y gastric bypass.

Key words: sleeve gastrectomy, gastroesophageal reflux, hiatal hernia, intra-thoracic sleeve migration