Ohnmacht Galen A, Deschamps Claude, Cassivi Stephen D, Nichols Francis C, Allen Mark S, Schleck Cathy D, Pairolero Peter C
Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Ann Thorac Surg. 2006 Jun;81(6):2050-3; discussion 2053-4. doi: 10.1016/j.athoracsur.2006.01.019.
Since laparoscopy has become a common surgical approach for antireflux surgery, little is known regarding reoperation for failed antireflux surgery.
Records of all patients who underwent reoperation without esophageal resection for symptoms of recurrent gastroesophageal reflux disease or hiatal hernia between July 1, 1995 and April 1, 2004 were reviewed. There were 126 patients. Two patients declined research participation. The remaining 124 patients (71 women and 53 men) formed the basis for this study. Median age was 53 years (range, 19 to 83 years). The initial operation was a laparoscopic antireflux procedure in 76 patients (61.3%) and an open repair in 48 (38.7%). A single previous operation had been done in 100 patients, two operations in 20, and three operations in 4. The median interval between the most recent reoperation and the previous operation was 28 months. All patients were symptomatic. The surgical approach was a thoracotomy in 83 patients, laparotomy in 36, laparoscopy in 4, and thoracoabdominal in 1. A Nissen fundoplication was performed in 86 patients (69.4%), Belsey fundoplication in 31(25.0%), and others in 7.
There were no operative deaths. Complications occurred in 27 patients (21.7%). Median hospitalization was 6 days (range, 5 to 58 days). Follow-up ranged from 10 days to 10 years (median, 9.7 months). Improvement was observed in 114 patients (91.9%). Functional results were classified as excellent in 69 patients (55.6%), good in 19 (15.4%), fair in 26 (20.9%), and poor in 10 (8.1%). No single operative approach was functionally superior.
We conclude that reoperation for failed antireflux surgery is safe and effective. Results of reoperation were not affected by the type of reoperation or whether the previous approach was laparoscopic or open.
自从腹腔镜检查成为抗反流手术的常用手术方法以来，对于抗反流手术失败后的再次手术了解甚少。
回顾了1995年7月1日至2004年4月1日期间所有因复发性胃食管反流病症状或食管裂孔疝而接受非食管切除术再次手术的患者记录。共有126例患者。2例患者拒绝参与研究。其余124例患者（71例女性和53例男性）构成了本研究的基础。中位年龄为53岁（范围19至83岁）。初次手术76例（61.3%）为腹腔镜抗反流手术，48例（38.7%）为开放修复术。100例患者曾接受过一次手术，20例接受过两次手术，4例接受过三次手术。最近一次再次手术与前一次手术的中位间隔时间为28个月。所有患者均有症状。手术方式为开胸手术83例，剖腹手术36例，腹腔镜手术4例，胸腹联合手术1例。行Nissen胃底折叠术86例（69.4%），Belsey胃底折叠术31例（25.0%），其他手术7例。
无手术死亡病例。27例患者（21.7%）发生并发症。中位住院时间为6天（范围5至58天）。随访时间从10天至10年（中位时间9.7个月）。114例患者（91.9%）病情改善。功能结果分类为优秀69例（55.6%），良好19例（15.4%），中等26例（20.9%），差10例（8.1%）。没有一种手术方式在功能上更具优势。
我们得出结论，抗反流手术失败后的再次手术是安全有效的。再次手术的结果不受再次手术类型或先前手术方式是腹腔镜还是开放手术的影响。
