Dally Elizabeth, Falk Gregory L
Department of Surgery, Concord Repatriation General Hospital, New South Wales, Australia.
Am J Surg. 2004 Feb;187(2):226-9. doi: 10.1016/j.amjsurg.2003.11.028.
Nissen fundoplication has become the standard operative procedure for the treatment of severe gastroesophageal reflux disease. The use of Teflon pledgets in Nissen fundoplications by our unit has been associated with a number of complications that has led to a change of technique in performing these operations.
We reviewed our database of all patients who had fundoplications that involved the use of pledgets and identified those who had represented with postoperative complications related to pledget erosion/migration.
We identified 11 patients to date from a total of 1,175 fundoplications who had symptomatic pledget erosion occurring between 2 and 85 months after surgery (mean time 33.3 months). Symptoms included dysphagia, recurrent symptomatic gastroesophageal reflux, chest pain, and melaena, and in some cases significant morbidity was associated with the erosion. No common factor predisposing these patients to pledget erosion was identified. In the majority of cases removal of the pledget was associated with resolution of the symptoms. A review of the literature does not reveal any similar studies but problems associated with the erosion and migration of Teflon prostheses are described.
The use of Teflon pledgets in fundoplication is associated with a small but significant risk of complications that has led to our unit abandoning this technique.
nissen胃底折叠术已成为治疗严重胃食管反流病的标准手术方法。我们科室在nissen胃底折叠术中使用特氟龙补片出现了一些并发症，这导致了该手术操作技术的改变。
我们回顾了所有接受使用补片的胃底折叠术患者的数据库，并确定了那些出现与补片侵蚀/移位相关术后并发症的患者。
截至目前，我们从总共1175例胃底折叠术中识别出11例患者，他们在术后2至85个月（平均时间33.3个月）出现了有症状的补片侵蚀。症状包括吞咽困难、复发性有症状的胃食管反流、胸痛和黑便，在某些情况下，侵蚀还伴有严重的发病率。未发现使这些患者易发生补片侵蚀的共同因素。在大多数情况下，取出补片后症状得到缓解。对文献的回顾未发现任何类似研究，但描述了与特氟龙假体侵蚀和移位相关的问题。
在胃底折叠术中使用特氟龙补片会带来虽小但显著的并发症风险，这导致我们科室放弃了该技术。
