van der Westhuizen Lionel, Dunphy Kaitlyn M, Knott Brianna, Carbonell Alfredo M, Smith Dane E, Cobb William S
Greenville Hospital System University Medical Center, Greenville, South Carolina, USA.
Am Surg. 2013 Jun;79(6):572-7.
Most authors recommend an antireflux operation at the time of laparoscopic paraesophageal hernia (PEH) repair. A fundoplication combats the potential postoperative reflux resulting from disruption of the hiatal anatomy and may minimize recurrence. The purpose of this study is to evaluate the differences in postoperative dysphagia, reflux symptoms, and hiatal hernia recurrence in patients with and without a fundoplication at the time of laparoscopic paraesophageal hernia repair. Patients undergoing laparoscopic PEH repair from July 2006 to June 2012 were identified. Open repairs and reoperative cases were excluded. Patient characteristics, operative details, complications, and postoperative outcomes were recorded. Over the six-year period, 152 laparoscopic PEH repairs were performed. Mean age was 65.8 years (range, 31 to 92) and average body mass index was 29.9 kg/m(2) (range, 18 to 52 kg/m(2)). Concomitant fundoplication was performed in 130 patients (86%), which was determined based on preoperative symptoms and esophageal motility. Mean operative times were similar with fundoplication (188 minutes) and without (184.5 minutes). At a mean follow-up of 13.9 months, there were 19 recurrences: 12.3 per cent (16 of 130) in the fundoplication group and 13.6 per cent (three of 22) in those without. Dysphagia lasting greater than six weeks was present in eight patients in the fundoplication group (6.2%) and in none in those without (P = 0.603). Eighteen percent of patients without a fundoplication reported postoperative reflux compared with 5.4 per cent of patients with a fundoplication (P = 0.055). In the laparoscopic repair of PEH, the addition of a fundoplication minimizes postoperative reflux symptoms without additional operative time. Neither dysphagia nor hiatal hernia recurrence is affected by the presence of a fundoplication.
大多数作者建议在腹腔镜治疗食管旁疝（PEH）时进行抗反流手术。胃底折叠术可对抗因裂孔解剖结构破坏导致的潜在术后反流，并可能减少复发。本研究的目的是评估在腹腔镜食管旁疝修补术时进行或不进行胃底折叠术的患者术后吞咽困难、反流症状及食管裂孔疝复发情况的差异。确定了2006年7月至2012年6月期间接受腹腔镜PEH修补术的患者。排除开放修补术和再次手术病例。记录患者特征、手术细节、并发症及术后结果。在这六年期间，共进行了152例腹腔镜PEH修补术。平均年龄为65.8岁（范围31至92岁），平均体重指数为29.9kg/m²（范围18至52kg/m²）。130例患者（86%）进行了同期胃底折叠术，这是根据术前症状和食管动力确定的。有胃底折叠术的平均手术时间（188分钟）与无胃底折叠术的（184.5分钟）相似。平均随访13.9个月时，有19例复发：胃底折叠术组为12.3%（130例中的16例），无胃底折叠术组为13.6%（22例中的3例）。胃底折叠术组有8例患者（6.2%）出现持续超过6周的吞咽困难，无胃底折叠术组无此情况（P = 0.603）。无胃底折叠术的患者中有18%报告术后有反流，而有胃底折叠术的患者为5.4%（P = 0.055）。在腹腔镜PEH修补术中，加做胃底折叠术可减少术后反流症状，且不增加手术时间。胃底折叠术的存在对吞咽困难和食管裂孔疝复发均无影响。
