Flinders University Department of Surgery, Flinders Medical Centre, Room 3D211, Bedford Park, Adelaide, South Australia 5042, Australia.
J Gastrointest Surg. 2012 Sep;16(9):1653-8. doi: 10.1007/s11605-012-1920-8. Epub 2012 May 26.
Nissen fundoplication can be followed by side effects, and this has driven modifications, including partial fundoplications. We previously reported early outcomes from a randomised trial of Nissen vs anterior 90° partial fundoplication. This paper reports 5-year follow-up outcomes to determine whether anterior 90° fundoplication achieves a satisfactory longer-term outcome.
From February 1999 to August 2003, 79 patients were randomised to Nissen vs anterior 90° fundoplication. Patients were followed yearly using a standardized clinical questionnaire which included symptom scores to assess heartburn, dysphagia, other post-fundoplication side effects and overall satisfaction with the outcome. Five-year clinical outcomes were analysed.
Seventy-four patients were available for follow-up at 5 years. There were no significant differences for heartburn or satisfaction, although more patients used antisecretory medication after anterior 90° fundoplication (29.7 vs 8.1 %). Dysphagia was greater after Nissen fundoplication when measured by an analogue score for solid food and a composite dysphagia score. Symptoms of bloating were more common following Nissen fundoplication (80.0 vs 32.4 %), and less patients could eat a normal diet (78.4 vs 94.6 %). Re-operation was undertaken in four patients after Nissen fundoplication (dysphagia, three; hiatus hernia, one) vs three after anterior 90° fundoplication (recurrent reflux, three).
At 5 years, anterior 90° partial fundoplication was associated with less side effects, offset by greater use of antisecretory medication. Reflux symptoms and overall satisfaction were similar to Nissen fundoplication. Laparoscopic anterior 90° partial fundoplication is an effective treatment for gastro-esophageal reflux.
尼森胃底折叠术可能会出现副作用，这促使人们进行了改良，包括部分胃底折叠术。我们之前报道过尼森胃底折叠术与前 90°部分胃底折叠术的随机试验的早期结果。本文报告了 5 年随访结果，以确定前 90°胃底折叠术是否能获得令人满意的长期效果。
1999 年 2 月至 2003 年 8 月，79 例患者被随机分为尼森胃底折叠术组和前 90°胃底折叠术组。患者每年通过标准化临床问卷进行随访，问卷包括症状评分，以评估烧心、吞咽困难、其他术后副作用和对手术结果的总体满意度。分析了 5 年的临床结果。
74 例患者在 5 年后可进行随访。两组在烧心或满意度方面无显著差异，但前 90°胃底折叠术后使用抗分泌药物的患者更多（29.7% vs 8.1%）。通过固体食物模拟评分和综合吞咽困难评分，尼森胃底折叠术后吞咽困难更大。尼森胃底折叠术后腹胀症状更常见（80.0% vs 32.4%），能正常进食的患者更少（78.4% vs 94.6%）。尼森胃底折叠术后有 4 例（吞咽困难 3 例，膈疝 1 例）患者再次手术，前 90°胃底折叠术后有 3 例（反流复发 3 例）患者再次手术。
5 年后，前 90°部分胃底折叠术的副作用较少，但需要更多使用抗分泌药物。反流症状和总体满意度与尼森胃底折叠术相似。腹腔镜前 90°部分胃底折叠术是治疗胃食管反流病的有效方法。
