Velanovich Vic, Ben Menachem Tamir
Division of General Surgery, Henry Ford Hospital, Detroit, Michigan 48202-2689, USA.
J Laparoendosc Adv Surg Tech A. 2002 Oct;12(5):305-8. doi: 10.1089/109264202320884027.
Endoscopic techniques to treat gastroesophageal reflux have been developed and approved by the U.S. Food and Drug Administration. One of these techniques is endoscopic gastroplication with the Bard Endocinch device. Although the technique is initially effective, long-term symptom control has not yet been proved. No reports have documented the feasibility of laparoscopic fundoplication after failed endoscopic gastroplication. We report our experience. Ten patients who underwent endoscopic gastroplication subsequently had recurrent symptoms and were referred for laparoscopic antireflux surgery. Eight had typical symptoms of gastroesophageal reflux disease (GERD), whereas two had atypical symptoms. All patients had documented pathologic reflux by 24-hour pH monitoring. Preoperatively, all patients completed the GERD health-related quality of life (HRQL) symptom severity questionnaire. Nine of the 10 operations were completed laparoscopically. The one conversion was carried out because of excessive fat in the hiatal region. No patients had scarring of the esophagus or hiatal region. All patients with typical symptoms improved (decrease in total GERD-HRQL median score from 27 to 4), whereas none of the patients with atypical symptoms did. Six patients had persistent dysphagia for longer than 1 month; two required esophageal dilation. Laparoscopic Nissen fundoplication is feasible after failed endoscopic gastroplication. Symptomatic improvement is similar to that with the de novo operation. However, in some patients, dysphagia may persist longer.
治疗胃食管反流的内镜技术已得到美国食品药品监督管理局的开发和批准。其中一种技术是使用巴德内镜套扎装置进行内镜胃折叠术。尽管该技术最初有效，但长期症状控制尚未得到证实。尚无报告记录内镜胃折叠术失败后腹腔镜胃底折叠术的可行性。我们报告我们的经验。10例接受内镜胃折叠术的患者随后出现症状复发，并被转诊进行腹腔镜抗反流手术。8例有胃食管反流病（GERD）的典型症状，而2例有非典型症状。所有患者均通过24小时pH监测记录有病理性反流。术前，所有患者均完成了GERD健康相关生活质量（HRQL）症状严重程度问卷。10例手术中有9例通过腹腔镜完成。1例中转是因为裂孔区域脂肪过多。没有患者出现食管或裂孔区域的瘢痕形成。所有有典型症状的患者均有改善（GERD-HRQL总中位数评分从27降至4），而所有有非典型症状的患者均无改善。6例患者持续吞咽困难超过1个月；2例需要进行食管扩张。内镜胃折叠术失败后，腹腔镜尼森胃底折叠术是可行的。症状改善与初次手术相似。然而，在一些患者中，吞咽困难可能会持续更长时间。
