BACKGROUND Prior studies have demonstrated an increase in gastroesophageal reflux after laparoscopic sleeve gastrectomy (LSG). However, it is unknown whether symptom severity varies or if outcomes are surgeon-specific. METHODS A validated reflux symptom survey was obtained at baseline and at 1 year after primary LSG on 7358 patients participating in a state-wide quality improvement collaborative between 2013 and 2018. Patients with worsening symptoms after surgery were divided into terciles based on the degree of increase in survey score (0 = no symptoms, 50 = max symptoms). Surgeon-level data was obtained on 52 bariatric surgeons performing at least 25 LSG cases/year during the study period. Surgeon characteristics, operative experience, and risk-adjusted 30-day complication rates were compared between surgeons in the highest tercile for moderate worsening of symptoms vs those in the lowest. RESULTS A total of 2294 (31.2%) patients had worsening symptoms of reflux after sleeve gastrectomy. Overall mean increase in severity score was 6.11 (range 1 to 48) and patients with minimal, mild, and moderate symptoms had a mean increase of 1.4, 4.2, and 13.8, respectively. There were no significant differences in surgeon-specific characteristics when comparing surgeons in the highest tercile for moderate worsening of symptoms (44.7% of patients) vs those in the lowest tercile (18.7% of patients). In addition, there were no significant differences in risk-adjusted rates of overall complications (3.70% vs. 4.33%, p = 0.686), endoscopic dilations (2.83% vs. 1.91%, p = 0.417), or concurrent hiatal hernia repair (34.3% vs. 27.0%, p = 0.415) between surgeons in the highest and lowest terciles. CONCLUSIONS We found that 1/3 of patients had worsening symptoms of reflux after LSG and that severity of symptoms varied. Surgeons with the highest rates of worsening reflux had similar operative experience and complication rates than those with the lowest. Further assessment of operative technique and skill may be informative.

中文翻译：

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袖状胃切除术后反流症状严重程度的外科医生变化。

背景 先前的研究表明，腹腔镜袖状胃切除术 (LSG) 后胃食管反流增加。然而，尚不清楚症状严重程度是否有所不同，或者结果是否因外科医生而异。方法 对 2013 年至 2018 年间参与全州质量改进协作的 7358 名患者在基线和初次 LSG 后 1 年进行了经过验证的反流症状调查。手术后症状恶化的患者根据增加的程度分为三等分调查得分（0 = 无症状，50 = 最大症状）。在研究期间，获得了 52 名减肥外科医生每年至少 25 例 LSG 病例的外科医生水平数据。外科医生特点、手术经验、比较了症状中度恶化最高三分位数的外科医生与最低三分位数的外科医生之间的风险调整后的 30 天并发症发生率。结果 袖状胃切除术后共有 2294 名 (31.2%) 患者出现反流症状恶化。严重程度评分的总体平均增加为 6.11（范围 1 至 48），轻度、轻度和中度症状患者的平均增加分别为 1.4、4.2 和 13.8。将最高三分位数的外科医生（44.7% 的患者）与最低三分位数的外科医生（18.7% 的患者）进行比较时，外科医生的特异性特征没有显着差异。此外，总体并发症的风险调整率（3.70% vs. 4.33%，p = 0.686）、内镜扩张（2.83% vs. 1.91%，p = 0.417）、或在最高和最低三分位的外科医生之间同时进行裂孔疝修补术（34.3% 对 27.0%，p = 0.415）。结论 我们发现 1/3 的患者在 LSG 后出现反流症状恶化，并且症状的严重程度各不相同。反流恶化率最高的外科医生与最低的外科医生有相似的手术经验和并发症发生率。对手术技术和技能的进一步评估可能会提供信息。