Dutta S, Bamehriz F, Boghossian T, Pottruff C Gill, Anvari M
Centre for Minimal Access Surgery, McMaster University, Hamilton, Ontario, Canada.
Surg Endosc. 2004 Mar;18(3):440-3. doi: 10.1007/s00464-003-8822-5. Epub 2004 Feb 2.
To date, there has been no objective evidence for the effectiveness of laparoscopic redo fundoplication. We therefore reviewed our experience and based our analysis on a number of objective parameters.
We prospectively followed 28 consecutive patients (five men and 23 women; mean age, 48.64 +/- 2.57 years) who required redo fundoplication. These patients were part of a series of laparoscopic Nissen fundoplications done between 1992 and 2001. The indications were recurrent symptoms of gastroesophageal reflux disease (GERD) (21 patients), acute herniation of the wrap (three patients), and chronic paraesophageal hernia (four patients). A diagnosis of recurrent GERD was based on endoscopy, 24-h pH study, manometry, and symptom score evaluation. A diagnosis of paraesophageal and acute herniation was based on contrast swallow studies and/or gastroscopy.
Twenty-six redo fundoplications were completed laparoscopically; two were converted to open. The mean operative time was 55.43 +/- 3.81 min. There were no intraoperative complications. The mean hospital stay was 3.0 +/- 0.35 days. Postoperative complications included postoperative pneumonia in one patient. Two patients from the laparoscopic group required a third operation-one for acute herniation of the redo wrap, which was fixed laparoscopically, and the other for acute recurrent paraesophageal hernia, which was fixed via an open transthoracic approach. The mean follow-up after revision is 25.14 +/- 3.48 months, with a significant decrease in acid reflux from 5.01% +/- 0.99 to 0.48% +/- 0.23 ( p < 0.0001), a significant decrease in symptom score from 28.96 +/- 2.93 to 10.75 +/- 2.61 ( p < 0.0001), and a small but significant increase in lower esophageal sphincter (LES) pressure from 13.71 +/- 1.79 to 16.69 +/- 1.50 ( p = 0.04).
Laparoscopic redo fundoplication is technically feasible and clinically effective over a 2-year objective follow-up. Conversion and complication rates are low.
迄今为止，尚无客观证据表明腹腔镜再次胃底折叠术有效。因此，我们回顾了我们的经验，并基于一些客观参数进行分析。
我们前瞻性地随访了28例连续需要再次胃底折叠术的患者（5例男性和23例女性；平均年龄48.64±2.57岁）。这些患者是1992年至2001年间一系列腹腔镜尼氏胃底折叠术患者的一部分。适应症为胃食管反流病（GERD）复发症状（21例患者）、胃底折叠术急性疝出（3例患者）和慢性食管旁疝（4例患者）。复发性GERD的诊断基于内镜检查、24小时pH值研究、测压和症状评分评估。食管旁疝和急性疝出的诊断基于吞咽造影研究和/或胃镜检查。
26例再次胃底折叠术通过腹腔镜完成；2例转为开放手术。平均手术时间为55.43±3.81分钟。无术中并发症。平均住院时间为3.0±0.35天。术后并发症包括1例患者发生术后肺炎。腹腔镜组的2例患者需要进行第三次手术，1例因再次胃底折叠术急性疝出，通过腹腔镜固定，另1例因急性复发性食管旁疝，通过开放经胸途径固定。翻修术后的平均随访时间为25.14±3.48个月，酸反流从5.01%±0.99显著降低至0.48%±0.23（p<0.0001），症状评分从28.96±2.93显著降低至10.75±2.61（p<0.0001），食管下括约肌（LES）压力略有但显著升高，从13.71±1.79升至16.69±1.50（p=0.04）。
在2年的客观随访中，腹腔镜再次胃底折叠术在技术上可行且临床有效。中转率和并发症发生率低。
