Eyuboglu Erhun, Ipek Turgut
Istanbul University, Department of General Surgery, Istanbul, Turkey.
Hepatogastroenterology. 2011 Sep-Oct;58(110-111):1607-10. doi: 10.5754/hge10654. Epub 2011 Jul 15.
BACKGROUND/AIMS: Since its original description in 1956 by Rudolph Nissen, minor changes were made in technical details of Nissen fundoplication. After the introduction of laparoscopic fundoplication, in order to reduce the rate of complications, some technical modifications led to the development of 'floppy' Nissen fundoplication.
From August 1993 to August 2009, laparoscopic Nissen fundoplication was performed on 2100 patients, 17 of whom underwent classical and 2083 underwent floppy fundoplication. All the operations were performed by the same surgical team. Preoperative work-up included 24-h pH monitoring, esophagogastroduodenoscopy and barium cineradiography. Esophageal manometry was not performed due to the physical impossibility of this tool at our clinic. Key steps of the operation were dissection of the hepatogastric and Laimer's ligament, dissection and closure of the hiatus, and short, floppy Nissen fundoplication. Phrenoesophageal ligament was divided to obtain at least of 4cm of an abdominal esophagus.
On the follow-up, dysphagia lasted for 1 month in 5.2% (110), between 1-3 months in 0.7% (16) and more than 3 months in 0.1% (3) of patients. Mortality was seen in 1 (0.05%) patient, and it was related to fatal pulmonary vein injury during perioperative bougienage.
Laparoscopic floppy Nissen fundoplication seems to be a safe and feasible technique for surgical treatment of gastroesophageal reflux disease.
背景/目的：自1956年鲁道夫·尼森首次描述该手术以来，尼森胃底折叠术的技术细节有了一些微小变化。在腹腔镜胃底折叠术引入后，为了降低并发症发生率，一些技术改进促成了“松弛型”尼森胃底折叠术的发展。
1993年8月至2009年8月，对2100例患者实施了腹腔镜尼森胃底折叠术，其中17例接受经典术式，2083例接受松弛型胃底折叠术。所有手术均由同一手术团队完成。术前检查包括24小时pH监测、食管胃十二指肠镜检查和钡剂动态造影。由于我们诊所无法使用该工具，未进行食管测压。手术的关键步骤包括肝胃韧带和莱默韧带的分离、裂孔的分离与闭合以及短而松弛的尼森胃底折叠术。切断膈食管韧带以获得至少4厘米长的腹段食管。
随访发现，5.2%（110例）患者吞咽困难持续1个月，0.7%（16例）患者持续1至3个月，0.1%（3例）患者持续超过3个月。1例（0.05%）患者死亡，与围手术期探条扩张时致命的肺静脉损伤有关。
腹腔镜松弛型尼森胃底折叠术似乎是治疗胃食管反流病的一种安全可行的手术技术。
