Ciovica Ruxandra, Riedl Otto, Neumayer Christoph, Lechner Wolfgang, Schwab Gerhard P, Gadenstätter Michael
Department of Surgery, General Hospital of Krems, Mitterweg 10, 3500, Krems, Austria.
Surg Endosc. 2009 Sep;23(9):1938-46. doi: 10.1007/s00464-008-0271-8. Epub 2009 Jan 24.
Laparoscopic antireflux surgery (LARS) significantly improves symptoms of gastro-esophageal reflux disease (GERD) and quality of life. Nevertheless, 14-62% of patients report using antisecretory medication after surgery, although only a tiny percentage has proven recurrence of GERD. We sought to determine symptoms of GERD, quality of life, and use of medication before and after LARS, and to compare our findings with those from previous studies.
Five hundred fifty-three patients with GERD who underwent LARS were evaluated before and at 1 year after surgery. After surgery, multidisciplinary follow-up care was provided for all patients by surgeons, psychologists, dieticians, and speech therapists.
Symptoms of GERD and quality of life improved significantly and only 4.2% of patients still required medication after surgery [proton pump inhibitors (PPI) (98.4 vs. 2.2%; p < 0.01), prokinetics (9.6 vs. 1.1%; p < 0.01), and psychiatric medication (8 vs. 1.6%; p < 0.01)].
LARS significantly reduced medication use at 1-year follow-up. However, these effects might be attributed, in part, to the multidisciplinary follow-up care. Further studies are therefore required to investigate which patients may benefit from multidisciplinary follow-up care and whether its selective application may reduce the need for medication after LARS.
腹腔镜抗反流手术（LARS）可显著改善胃食管反流病（GERD）的症状及生活质量。然而，14% - 62%的患者术后仍需使用抗分泌药物，尽管只有极小比例的患者被证实存在GERD复发。我们旨在确定LARS手术前后GERD的症状、生活质量及药物使用情况，并将我们的研究结果与既往研究进行比较。
对553例行LARS手术的GERD患者在术前及术后1年进行评估。术后，外科医生、心理医生、营养师和言语治疗师为所有患者提供多学科随访护理。
GERD症状及生活质量显著改善，术后仅4.2%的患者仍需用药[质子泵抑制剂（PPI）（98.4%对2.2%；p < 0.01）、促动力药（9.6%对1.1%；p < 0.01）及精神类药物（8%对1.6%；p < 0.01）]。
LARS在1年随访时显著减少了药物使用。然而，这些效果可能部分归因于多学科随访护理。因此，需要进一步研究以调查哪些患者可能从多学科随访护理中获益，以及其选择性应用是否可减少LARS术后的药物需求。
