Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-5126, USA.
Surg Endosc. 2011 May;25(5):1458-65. doi: 10.1007/s00464-010-1414-2. Epub 2010 Oct 29.
Patients undergoing laparoscopic paraesophageal herniorrhaphy present with various esophageal and extraesophageal symptoms. Given a recurrence rate of up to 44%, reoperative intervention is necessary on a number of patients. The goal of this study is to determine whether patients proceeding with reoperative laparoscopic paraesophageal herniorrhaphy experienced symptom resolution equal to or better than patients undergoing first-time repair.
A frequency-based symptom assessment consisting of 24 esophageal and extraesophageal reflux symptoms was developed and administered pre- and postoperatively to patients undergoing initial or reoperative paraesophageal herniorrhaphy during a 7-year period. A composite score for esophageal and extraesophageal symptoms was calculated. Retrospective analysis of patient records including diagnostic studies, and operative and postoperative progress notes was performed. Data were analyzed using appropriate statistical tests.
In 195 patients, 89.9% of patients had resolved or improved individual symptom scores at 6 months postoperatively after primary or reoperative paraesophageal herniorrhaphy. Paraesophageal herniorrhaphy resulted in improvements of both esophageal (16.1±8.5 preoperatively versus 3.5±5.0 at 6 months postoperatively; p<0.001) and extraesophageal (8.6±7.5 preoperatively versus 2.2±5.1 at 6 months postoperatively; p<0.001) composite scores and all individual symptom scores (p<0.05). Preoperatively, patients undergoing reoperative surgery had significantly higher solid dysphagia and abdominal discomfort, but lower odynophagia scores. Furthermore, reoperative patients had significantly lower preoperative composite extraesophageal scores (6.1±7.2 reoperative versus 9.1±7.5 primary; p<0.05) and individual symptom scores in laryngitis, hoarseness, and coughing. Only heartburn in reoperative patients was significantly higher at 12 months postoperatively. Otherwise, there was no significant difference in individual or composite symptom scores between groups postoperatively. All scores had significant improvement postoperatively when compared with preoperative scores.
Our data demonstrate that reoperative laparoscopic paraesophageal herniorrhaphy can produce excellent results, comparable to first-time repair.
行腹腔镜食管裂孔疝修补术的患者表现出各种食管和食管外症状。由于复发率高达 44%，许多患者需要再次手术干预。本研究的目的是确定再次行腹腔镜食管裂孔疝修补术的患者的症状缓解程度是否与首次手术修复的患者相当或更好。
采用基于频率的症状评估，包括 24 项食管和食管外反流症状，在 7 年内对接受初次或再次腹腔镜食管裂孔疝修补术的患者进行术前和术后评估。计算食管和食管外症状的综合评分。对包括诊断研究、手术和术后进展记录在内的患者记录进行回顾性分析。使用适当的统计检验对数据进行分析。
在 195 例患者中，89.9%的患者在初次或再次腹腔镜食管裂孔疝修补术后 6 个月时，个体症状评分得到缓解或改善。食管裂孔疝修补术改善了食管（术前 16.1±8.5，术后 6 个月 3.5±5.0；p<0.001）和食管外（术前 8.6±7.5，术后 6 个月 2.2±5.1；p<0.001）综合评分以及所有个体症状评分（p<0.05）。术前，再次手术患者的固体吞咽困难和腹部不适评分明显较高，但咽喉痛评分较低。此外，再次手术患者的术前复合食管外症状评分（6.1±7.2 再次手术组与 9.1±7.5 初次手术组；p<0.05）和声带炎、声音嘶哑和咳嗽等单项症状评分明显较低。只有再次手术患者的术后 12 个月的烧心症状评分明显较高。否则，两组术后的单项或综合症状评分无明显差异。与术前评分相比，所有评分在术后均有显著改善。
我们的数据表明，再次行腹腔镜食管裂孔疝修补术可以获得与初次手术相当的出色结果。
