Riedl Otto, Gadenstätter Michael, Lechner Wolfgang, Schwab Gerhard, Marker Martina, Ciovica Ruxandra
Department of Surgery, General Hospital of Krems, Krems, Austria.
J Gastrointest Surg. 2009 Jul;13(7):1189-97. doi: 10.1007/s11605-009-0890-y. Epub 2009 Apr 16.
Experience with laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) and manometrically intact lower esophageal sphincter (LES) is limited. The disease pattern may be different and LARS may fail to control reflux or result in higher rates of dysphagia. This is the first study investigating the impact of preoperative LES manometry data not only on manifestations of GERD and subjective outcome alone but also on objective outcomes 1 year after LARS.
Three hundred fifty-one GERD patients underwent LARS and had subjective symptom and quality of life assessment, upper gastrointestinal endoscopy, barium swallow esophagogram, 24-h esophageal pH monitoring, and manometry pre- and 1 year postoperatively. Patients were divided into those with a preoperatively intact versus defective LES based on intraabdominal length and resting pressure. Baseline and 1-year postoperative follow-up data were compared.
Preoperative manifestations of GERD were similar in each group. Postoperatively, all symptoms except flatulence, quality of life scores, and objective manifestations improved significantly in each group.
The preoperative manometric character of the LES neither impacts the manifestations of GERD nor subjective and objective outcomes after LARS. Patients with GERD and manometrically intact LES have no higher risk for postoperative dysphagia.
腹腔镜抗反流手术（LARS）应用于胃食管反流病（GERD）且食管下括约肌（LES）测压正常的患者的经验有限。疾病模式可能不同，LARS可能无法控制反流或导致吞咽困难发生率更高。这是第一项不仅研究术前LES测压数据对GERD表现和主观结果的影响，还研究其对LARS术后1年客观结果影响的研究。
351例GERD患者接受了LARS手术，并在术前和术后1年进行了主观症状和生活质量评估、上消化道内镜检查、吞钡食管造影、24小时食管pH监测以及测压。根据腹内长度和静息压力将患者分为术前LES正常组和异常组。比较基线数据和术后1年的随访数据。
每组GERD的术前表现相似。术后，除腹胀、生活质量评分和客观表现外，每组所有症状均有显著改善。
LES的术前测压特征既不影响GERD的表现，也不影响LARS术后的主观和客观结果。GERD且LES测压正常的患者术后发生吞咽困难的风险并不更高。
