Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Ann Thorac Surg. 2011 Sep;92(3):1083-9; discussion 1089-90. doi: 10.1016/j.athoracsur.2011.02.088. Epub 2011 Jul 29.
With an increase in the performance of laparoscopic antireflux procedures, more patients with a failed primary antireflux operation are being referred to thoracic surgeons for complex redo procedures. The objective of this study was to evaluate our results of redo antireflux surgery.
We conducted a retrospective review of patients who underwent redo surgery for failed fundoplication. The primary endpoint was failure of the redo operation; other endpoints included gastroesophageal reflux disease-health-related quality of life (HRQOL) after redo fundoplication.
A total of 275 patients (median age, 52 years; range, 17 to 88 years; men 82, women 193) underwent redo antireflux surgery. The most common pattern of failure of the initial operation was transmediastinal migration-recurrent hernia in 177 patients (64%). Redo surgery included Nissen fundoplication in 200 (73%), Collis gastroplasty in 119 (43%), and partial fundoplication in 41 (15%). There was no perioperative mortality. At a median follow-up of 39.6 months, 31 patients (11.2%) had a failure of the redo surgery, requiring reoperation. The two-year estimated probability of freedom from failure was 93% (95% confidence interval 89% to 96%). The HRQOL scores, available for 186 patients, were excellent to satisfactory in 85.5%, and poor in 14.5%.
Redo antireflux surgery can be performed safely in experienced centers with outcomes that are similar to published open results. Complete takedown and reestablishment of the normal anatomy, recognition of a short esophagus, and proper placement of the wrap are essential components of the procedure. Thoracic surgeons with significant laparoscopic and open esophageal surgical experience can perform minimally invasive, complex redo esophageal antireflux procedures safely with good results.
随着腹腔镜抗反流手术性能的提高，越来越多初次抗反流手术失败的患者被转介给胸外科医生进行复杂的再次手术。本研究的目的是评估我们再次抗反流手术的结果。
我们对因初次胃底折叠术失败而接受再次手术的患者进行了回顾性研究。主要终点是再次手术失败；其他终点包括再次胃底折叠术后胃食管反流病相关健康相关生活质量（HRQOL）。
共有 275 例（中位年龄 52 岁，范围 17-88 岁；男性 82 例，女性 193 例）患者接受了再次抗反流手术。初次手术失败的最常见模式是纵隔移位-复发性疝，共 177 例（64%）。再次手术包括 Nissen 胃底折叠术 200 例（73%）、Collis 胃成形术 119 例（43%）和部分胃底折叠术 41 例（15%）。无围手术期死亡。中位随访 39.6 个月时，31 例（11.2%）再次手术失败，需要再次手术。两年无失败概率估计为 93%（95%置信区间 89%-96%）。可获得 186 例患者的 HRQOL 评分，85.5%为优或良，14.5%为差。
在有经验的中心，再次抗反流手术可以安全进行，其结果与已发表的开放性结果相似。彻底切除和重建正常解剖结构、识别短食管和正确放置包裹物是该手术的重要组成部分。具有丰富腹腔镜和开放性食管外科经验的胸外科医生可以安全地进行微创、复杂的再次食管抗反流手术，并取得良好的效果。
