開腹スリーブ状胃切除後の難治性逆流性食道炎に対して腹腔鏡下修正手術を要した1例

Laparoscopic Roux-en-Y gastric bypass for refractory GERD after sleeve gastrectomy : A case report

◆要旨：患者は64歳，女性．高度肥満症に対しスリーブ状胃切除術（SG）を施行した．術後8か月より心窩部痛・嘔吐が出現し，精査にて胃管の捻れと逆流性食道炎を認めた．内視鏡下バルーン拡張術を施行したが効果は限定的で，逆流性食道炎の増悪に伴い食事摂取も困難となったため，術後33か月に腹腔鏡下Roux-en-Y胃バイパス術への修正手術を行った．本例の難治性逆流性食道炎は，術後に増悪した食道裂孔ヘルニアにより胃管が縦隔内に入り込み，屈曲が生じたことが原因と考えられた．SGの症例数増加に伴い，同様な合併症も一定の割合で生じる可能性が高いと考えられ，SG施行にあたっては発生しうる合併症やその対処法を持ち合せておくことが必須となる．

A 64-year-old morbidly obese woman underwent sleeve gastrectomy（SG）. She had a progressively worsening case of epigastralgia and vomiting eight months after surgery. Upper gastrointestinal imaging and endoscopy showed torsion of the gastric tube associated with severe gastroesophageal reflux disease. Several failures of endoscopic balloon dilations finally necessitated a revisional laparoscopic Roux-en-Y gastric bypass thirty-three months after the original surgery. An aggravated hiatal hernia after SG caused the upper gastric tube to protrude into the mediastinum, and this was followed by intractable torsion. In consideration of the current obesity and metabolic disease problems in Japan, the number of sleeve gastrectomies is predicted to increase greatly in the near future. Although SG is a simple operation, we should know the potential SG-related complications and the optimal management approach for a safe outcome.