Granderath F A, Kamolz T, Schweiger U M, Pasiut M, Haas C F, Wykypiel H, Pointner R
Department of General Surgery, Hospital Zell am See, Paracelsusstrasse 8, 5700 Zell am See, Austria.
Surg Endosc. 2002 Mar;16(3):381-5. doi: 10.1007/s00464-001-9102-x. Epub 2001 Dec 17.
Due to the widespread availability and acceptance of minimal-access surgery, laparoscopic antireflux surgery has become the standard procedure for the treatment of severe gastroesophageal reflux disease (GERD). However, open and laparoscopic antireflux procedures sometimes result in failure, so that redosurgery is required in some cases. The aim of this prospective study was to evaluate the surgical outcome and quality of life of patients who underwent refundoplication after the failure of primary open antireflux surgery.
Twenty patients with a mean age of 52 years (range, 33-69) underwent laparoscopic refundoplication after primary open antireflux surgery. Four of them had undergone surgery twice previously. Preoperative and postoperative data, including esophageal manometry, 24-h pH monitoring, and assessment of quality of life, were reviewed prospectively. Quality of life was evaluated using the Gastrointestinal Quality of Life Index (GIQLI).
In 18 patients (90%), the reoperation was completed successfully laparoscopically. Two others (10%) required conversion to an open procedure. One of them had an injury of the gastric wall; in the other case, severe bleeding of the spleen necessitated the conversion. The average operating time was 245 min. Preoperatively, the main symptoms were recurrent reflux in 14 cases and a combination of re-reflux and dysphagia in six cases. The anatomic findings were telescope phenomenon (n = 6), hiatal disruption (n = 10), and wrap breakdown (n = 4). Postoperatively, two patients suffered from dysphagia and required pneumatic dilatation. The lower esophageal sphincter (LES) pressure increased significantly from a preoperative value of 6.08 mmHg to 12.2 mmHg at 3 months and 11.9 mmHg at 1 year after surgery. The DeMeester score decreased from a preoperative value of 69.8 to 17.1 at 3 months and 14.6 at 1 year postoperatively. The GIQLI score increased from a preoperative value of 84.9 points to 119.6 points at 3 months and 120.1 points at 1 year.
Laparoscopic refundoplication after the failure of a primary open intervention is an effective procedure that can be performed safely by experienced laparoscopic surgeon. The procedure yields excellent functional results and leads to significant improvement in the patient's quality of life.
由于微创外科手术的广泛应用和接受度，腹腔镜抗反流手术已成为治疗重度胃食管反流病（GERD）的标准术式。然而，开放和腹腔镜抗反流手术有时会失败，因此在某些情况下需要再次手术。这项前瞻性研究的目的是评估初次开放抗反流手术失败后接受再次胃底折叠术患者的手术结果和生活质量。
20例平均年龄52岁（范围33 - 69岁）的患者在初次开放抗反流手术后接受了腹腔镜再次胃底折叠术。其中4例患者此前已接受过两次手术。前瞻性地回顾术前和术后数据，包括食管测压、24小时pH监测以及生活质量评估。使用胃肠道生活质量指数（GIQLI）评估生活质量。
18例患者（90%）腹腔镜再次手术成功完成。另外2例（10%）需要转为开放手术。其中1例胃壁损伤；另1例因脾脏严重出血而转为开放手术。平均手术时间为245分钟。术前，主要症状为14例反复反流，6例反流与吞咽困难并存。解剖学发现为套叠现象（n = 6）、食管裂孔破坏（n = 10）和胃底折叠破裂（n = 4）。术后，2例患者出现吞咽困难，需要进行气囊扩张。术后3个月时，食管下括约肌（LES）压力从术前的6.08 mmHg显著增加至12.2 mmHg,术后1年时为11.9 mmHg。DeMeester评分从术前的69.8降至术后3个月时的17.1，术后1年时为14.6。GIQLI评分从术前的84.9分升至术后3个月时的119.6分，术后1年时为120.1分。
初次开放干预失败后进行腹腔镜再次胃底折叠术是一种有效的手术，经验丰富的腹腔镜外科医生可安全实施。该手术产生优异的功能结果，并使患者的生活质量得到显著改善。
