Kamolz Thomas, Granderath Frank A, Bammer Tanja, Pasiut Martin, Pointner Rudolph
Department of General Surgery, Hospital Zell am See, Zell am See, Austria.
Hepatogastroenterology. 2002 May-Jun;49(45):865-8.
BACKGROUND/AIMS: Antireflux surgery has a failure rate between 5 and 20%. Laparoscopic redo-surgery is feasible, but little is known about the surgical outcome in elderly patients. The aim of this prospective study was to evaluate early surgical experience and outcome, including quality of life, after laparoscopic refundoplication in patients older than 65 years.
Eleven patients, mean age of 71 years (range: 65-78), underwent laparoscopic redo-surgery. Six patients had the former antireflux procedure performed by the open technique, one having had it twice, one had both laparoscopic and open antireflux procedures, and in 4 the primary intervention was performed laparoscopically. Quality of life was evaluated by using the Gastrointestinal Quality of Life Index. All patients were evaluated prior to surgery, and at 3 months and 12 months after laparoscopic refundoplication, as well as with esophageal manometry and 24-hour pH-monitoring.
Redo-procedures were completed laparoscopically in 10 patients. In one patient conversion to an open laparotomy was necessary because of severe bleeding from the spleen. One patient had an injury to the gastric wall, successfully managed laparoscopically. Postoperatively, one patient had moderate dysphagia for a period of two months, another had epigastric pain for the same period. Esophageal manometry and 24-hour pH-monitoring showed normal values in all patients after redo-surgery. Prior to redo-surgery, the mean Gastrointestinal Quality of Life Index was 85.2 points. Three months (mean: 119.8 points) and one year (mean: 119.2 points) after laparoscopic reoperation the general score increased significantly (P < 0.01) and attained the equivalent level of comparable healthy individuals (118.7 points).
Laparoscopic refundoplication in the elderly patient is feasible, safe and an effective treatment after failed antireflux surgery. Older patients with failed antireflux surgery have poor quality of life. Laparoscopic redo-surgery improves quality of life significantly to the level of healthy individuals and normalizes objective outcome criteria without any long-term restrictions in daily life.
背景/目的：抗反流手术的失败率在5%至20%之间。腹腔镜再次手术是可行的，但对于老年患者的手术结果了解甚少。这项前瞻性研究的目的是评估65岁以上患者行腹腔镜胃底折叠术的早期手术经验和结果，包括生活质量。
11例患者，平均年龄71岁（范围：65 - 78岁），接受了腹腔镜再次手术。6例患者曾接受过开放技术的抗反流手术，其中1例接受过两次，1例同时接受过腹腔镜和开放抗反流手术，4例的初次干预是通过腹腔镜进行的。使用胃肠道生活质量指数评估生活质量。所有患者在手术前、腹腔镜胃底折叠术后3个月和12个月进行评估，并进行食管测压和24小时pH监测。
10例患者通过腹腔镜完成了再次手术操作。1例患者因脾脏严重出血而需要转为开腹手术。1例患者胃壁受损，通过腹腔镜成功处理。术后，1例患者有两个月的中度吞咽困难，另1例同期有上腹部疼痛。再次手术后所有患者的食管测压和24小时pH监测显示值均正常。再次手术前，胃肠道生活质量指数平均为85.2分。腹腔镜再次手术后3个月（平均：119.8分）和1年（平均：119.2分），总体评分显著提高（P < 0.01），达到了健康对照个体的同等水平（118.7分）。
老年患者行腹腔镜胃底折叠术是可行、安全且有效的抗反流手术失败后的治疗方法。抗反流手术失败的老年患者生活质量较差。腹腔镜再次手术可将生活质量显著提高到健康个体的水平，并使客观结果标准正常化，且日常生活无任何长期限制。
