Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA.
Surg Endosc. 2012 Dec;26(12):3521-7. doi: 10.1007/s00464-012-2380-7. Epub 2012 Jun 13.
Recent data suggest that reoperative fundoplication is associated with poor long-term control of reflux. For long-term reflux control, laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a better option. This study assessed outcomes and quality-of-life data after fundoplication takedown and conversion to LRYGB for patients with failed fundoplications.
After institutional review board approval, the medical records of 25 patients who underwent fundoplication takedown and LRYGB conversion between March 2007 and July 2011 were reviewed. The data recorded included patient demographics, body mass index (BMI), preoperative symptoms, operative duration and findings, hospital length of stay (LOS), estimated blood loss (EBL), length of the follow-up period, and postoperative outcomes. The gastrointestinal quality of life index (GIQLI) and the gastrointestinal symptoms rating scale (GSRS) were used at the most recent follow-up visit to assess symptom severity and quality of life.
The patients in this study had undergone 40 total prior antireflux surgeries. They had a median age of 55 years (range 36-72 years), a BMI of 34.4 kg/m(2) (range 22-50 kg/m(2)), an operative duration of 345 min (range 180-600 min), an EBL of 181 ml (range 50-500 ml), and an LOS of 7 days (range 2-30 days). Five patients had concomitant incisional hernia repair. There was no mortality. Of the 10 patients (40%) who had had complications, 5 required reoperation. During a 14-month follow-up period (range 1-48 months), 96% of the patients were reflux-free with a GIQLI score of 114 (range 80-135) and a GSRS score of 25 (range 17-45). Excess weight loss was 60%, and comorbidity resolution was 70%. Most of the patients (96%) were satisfied with their outcome and would undergo the surgery again, and 62% reported that their personal relationships and sexual life had improved.
Patients who undergo LRYGB after failed fundoplications have excellent symptomatic control of reflux, excellent quality of life, and high rates of satisfaction with their outcome. Nevertheless, because the procedure is challenging and associated with considerable morbidity, it should be performed by surgeons experienced in antireflux and bariatric surgery.
最近的数据表明，再次进行胃底折叠术与较差的长期反流控制有关。为了长期控制反流，腹腔镜 Roux-en-Y 胃旁路术（LRYGB）可能是更好的选择。本研究评估了因胃底折叠术失败而进行胃底折叠术切除和 LRYGB 转换的患者的手术结果和生活质量数据。
在获得机构审查委员会批准后，回顾了 2007 年 3 月至 2011 年 7 月期间接受胃底折叠术切除和 LRYGB 转换的 25 名患者的病历。记录的数据包括患者人口统计学、体重指数（BMI）、术前症状、手术时间和发现、住院时间（LOS）、估计失血量（EBL）、随访时间和术后结果。使用胃肠道生活质量指数（GIQLI）和胃肠道症状评分量表（GSRS）在最近的随访中评估症状严重程度和生活质量。
本研究中的患者总共进行了 40 次抗反流手术。他们的中位年龄为 55 岁（范围 36-72 岁），BMI 为 34.4kg/m²（范围 22-50kg/m²），手术时间为 345 分钟（范围 180-600 分钟），EBL 为 181ml（范围 50-500ml），LOS 为 7 天（范围 2-30 天）。5 例患者同时行切口疝修补术。无死亡病例。在 10 例（40%）发生并发症的患者中，有 5 例需要再次手术。在 14 个月的随访期（范围 1-48 个月）内，96%的患者无反流，GIQLI 评分为 114（范围 80-135），GSRS 评分为 25（范围 17-45）。超重减轻了 60%，合并症缓解率为 70%。大多数患者（96%）对手术结果满意，并愿意再次接受手术，62%的患者报告称个人关系和性生活有所改善。
胃底折叠术失败后行 LRYGB 的患者对反流有极好的症状控制，生活质量极好，对手术结果的满意度很高。然而，由于该手术具有挑战性且并发症发生率较高，因此应由经验丰富的抗反流和减重手术医生进行。
