Department of General Surgery, General Hospital Zell am See, Paracelsusstrasse 8, 5700, Zell am See, Austria.
Surg Endosc. 2012 Feb;26(2):413-22. doi: 10.1007/s00464-011-1889-5. Epub 2011 Sep 5.
Although symptom outcomes following laparoscopic fundoplication have been adequately evaluated in the past, comparative subjective data of laparoscopic Nissen and Toupet fundoplications are scarce. Multichannel intraluminal impedance monitoring (MII) has not been used so far for comparison of objective data.
One hundred patients with documented chronic gastroesophageal reflux disease (GERD) were randomly allocated to either floppy Nissen fundoplication (group I, n = 50) or Toupet fundoplication (group II, n = 50). Gastrointestinal Quality of Life Index (GIQLI), symptom grading, esophageal manometry, and MII data were documented preoperatively and 3 months after surgery. Subjective and objective outcome data were compared to those of healthy individuals.
Symptom intensity was significantly more severe and GIQLI showed impairment in the examined patient population compared to healthy controls. Both procedures resulted in a significant improvement in GIQLI and GERD symptoms (p < 0.01). Dysphagia improved significantly only in group II, while cough, asthma, and distortion of taste improved significantly in both groups. Hoarseness symptoms showed some degree of improvement in both groups but reached statistical significance only in group I. Postoperatively, bowel symptoms partly increased and the ability to belch decreased in both groups (p < 0.05). Comparison of postoperative GIQLI and symptom scores showed no significant difference between the two groups, except for the ability to belch, which was more impaired after Nissen fundoplication. Both procedures resulted in a significant improvement in lower esophageal sphincter (LES) pressure; however, the improvement was greater in group I than in group II. MII data showed more reflux control after Nissen, but the differences between the procedures were not significant.
Both procedures equally improve quality of life and GERD symptoms. Bowel symptoms may increase after both procedures at the 3-month follow-up. Manometry and MII data favor Nissen fundoplication, but dysphagia and the inability to belch are more common compared to Toupet fundoplication.
尽管腹腔镜胃底折叠术的症状结果在过去已经得到了充分的评估，但腹腔镜 Nissen 和 Toupet 胃底折叠术的比较主观数据却很少。多通道腔内阻抗监测（MII）至今尚未用于比较客观数据。
100 例经证实的慢性胃食管反流病（GERD）患者被随机分为松软 Nissen 胃底折叠术（I 组，n=50）或 Toupet 胃底折叠术（II 组，n=50）。术前和术后 3 个月记录胃肠道生活质量指数（GIQLI）、症状分级、食管测压和 MII 数据。将主观和客观的结果数据与健康个体进行比较。
与健康对照组相比，检查患者人群的症状强度明显更严重，GIQLI 显示受损。两种手术均显著改善了 GIQLI 和 GERD 症状（p<0.01）。仅在 II 组中，吞咽困难显著改善，而咳嗽、哮喘和味觉失真在两组中均显著改善。两组的声音嘶哑症状均有一定程度的改善，但仅在 I 组中达到统计学意义。术后，两组的肠症状部分增加，打嗝能力下降（p<0.05）。两组术后 GIQLI 和症状评分的比较除了 Nissen 胃底折叠术后打嗝能力受损外，无显著差异。两种手术均显著改善了食管下括约肌（LES）压力；然而，I 组的改善程度大于 II 组。MII 数据显示 Nissen 术后反流控制更好，但两种手术之间的差异无统计学意义。
两种手术均能同等改善生活质量和 GERD 症状。在 3 个月的随访中，两种手术均可能导致肠症状增加。测压和 MII 数据有利于 Nissen 胃底折叠术，但与 Toupet 胃底折叠术相比，吞咽困难和不能打嗝更为常见。
