Department of Surgery, Gastrointestinal Research Unit, University Medical Center Utrecht, Utrecht, The Netherlands.
Ann Surg. 2012 Jan;255(1):59-65. doi: 10.1097/SLA.0b013e31823899f8.
To investigate differences in effects of 270 degrees (270 degrees LPF) and 360 degrees laparoscopic posterior fundoplication (360 degrees LPF) on reflux characteristics and belching.
Three hundred sixty degrees LPF greatly reduces the ability of the stomach to vent ingested air by gastric belching. This frequently leads to postoperative symptoms including inability to belch, gas bloating and increased flatulence. Two hundred seventy degrees LPF allegedly provides less effective reflux control compared with 360 degrees LPF, but theoretically may allow for gastric belches (GBs) with a limitation of gas-related symptoms.
Endoscopy, stationary esophageal manometry, and 24-hour impedance-pH monitoring off PPIs was performed before and 6 months after fundoplication for PPI-refractory gastroesophageal reflux disease (n = 14 270 degrees LPF vs. n = 28 360 degrees LPF). GBs were defined as gas components of pure gas and mixed reflux episodes reaching the proximal esophagus. Absolute reductions (Δ) were compared.
Reflux symptoms and the 24-hour incidence of acid (Δ -77.6 vs. -76.7), weakly acidic (Δ -9.4 vs. -6.6), liquid (Δ -59.0 vs. -49.8) and mixed reflux episodes (Δ -28.0 vs. -33.5) were reduced to a similar extent after 270° LPF and 360° LPF, respectively. The reduction in proximal, mid-esophageal and distal reflux episodes were similar in both groups as well. Persistent symptoms were not related to acid or weakly acidic reflux. Two hundred seventy degrees LPF had no significant impact on the number of gas reflux episodes (Δ -3.6; P = 0.363), whereas 360 degrees LPF significantly reduced gas reflux episodes (Δ -17.0; P = 0.002). After 270 degrees LPF, GBs (Δ -29.3 vs. -50.6; P = 0.026) were significantly less reduced and the prevalence of gas bloating (7.1% vs. 21.4%; P = 0.242) and increased flatulence (7.1% vs. 42.9%; P = 0.018) was lower compared to 360 degrees LPF. Twenty-eight patients (67%) showed supragastric belches (SGBs) before and after surgery. The increase in SGBs without reflux (Δ +32.4 vs. +25.5) and the decrease in reflux-associated SGBs (Δ -12.1 vs. -14.0) were similar after 270 degrees LPF and 360 degrees LPF.
Two hundred seventy degrees LPF and 360 degrees LPF alter the belching pattern by reducing GBs (air venting from stomach) and increasing SGBs (no air venting from stomach). However, gas reflux and GBs are reduced less after 270 degrees LPF than after 360 degrees LPF, resulting in more air venting from the stomach and less gas bloating and flatulence, whereas reflux is reduced to a similar extent in the short-term.
研究 270 度（270 度 LPF）和 360 度腹腔镜胃底折叠术（360 度 LPF）对反流特征和呃逆的影响差异。
360 度 LPF 极大地降低了胃通过胃嗳气排出摄入气体的能力。这常常导致术后症状，包括无法嗳气、气体腹胀和增加的气胀。270 度 LPF 据称与 360 度 LPF 相比，提供的反流控制效果较差，但理论上可能允许胃嗳气（GBs），但存在与气体相关的症状限制。
对 14 例接受 270 度 LPF（n = 14）和 28 例接受 360 度 LPF（n = 28）的质子泵抑制剂（PPI）难治性胃食管反流病患者进行内镜、静止食管测压和 24 小时阻抗-pH 监测。GBs 定义为到达近端食管的纯气和混合反流事件中的气体成分。比较绝对减少量（Δ）。
270 度 LPF 和 360 度 LPF 后，反流症状和 24 小时酸（Δ-77.6 与-76.7）、弱酸性（Δ-9.4 与-6.6）、液体（Δ-59.0 与-49.8）和混合反流事件（Δ-28.0 与-33.5）的发生率均显著降低。两组近端、中段和远端反流事件的减少程度相似。持续性症状与酸或弱酸性反流无关。270 度 LPF 对气体反流事件的数量没有显著影响（Δ-3.6；P = 0.363），而 360 度 LPF 显著减少了气体反流事件（Δ-17.0；P = 0.002）。在 270 度 LPF 后，GBs（Δ-29.3 与-50.6；P = 0.026）显著减少，气体腹胀（7.1%与 21.4%；P = 0.242）和增加的气胀（7.1%与 42.9%；P = 0.018）的发生率也较低。28 例患者（67%）在术前和术后均出现胃上嗳气（SGBs）。270 度 LPF 和 360 度 LPF 后，无反流的 SGBs 增加（Δ+32.4 与+25.5）和与反流相关的 SGBs 减少（Δ-12.1 与-14.0）相似。
270 度 LPF 和 360 度 LPF 通过减少 GBS（胃内气体排出）和增加 SGBs（胃内无气体排出）来改变嗳气模式。然而，270 度 LPF 后 GBS 和气体反流的减少程度低于 360 度 LPF，导致更多的胃内气体排出和更少的气体腹胀和气胀，而反流在短期内减少到相似的程度。
