Makdisi George, Nichols Francis C, Cassivi Stephen D, Wigle Dennis A, Shen K Robert, Allen Mark S, Deschamps Claude
Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
Ann Thorac Surg. 2014 Oct;98(4):1261-6. doi: 10.1016/j.athoracsur.2014.05.036. Epub 2014 Aug 13.
Minimally invasive procedures have become common, and more reoperations for failed antireflux procedures are performed laparoscopically. We wanted to study the outcomes of laparoscopic reoperations for reflux.
Medical records of all patients who underwent reoperation without esophageal resection after previous antireflux procedures between January 2000 and October 2012 were reviewed.
Seventy-five patients were included in this report: 56 (77%) women and 19 (23%) men. Median age was 58 years. The previous operation was laparoscopic antireflux procedures in 65 (87%) patients. The median interval between the last antireflux procedure and laparoscopic reoperation was 42 months. The median body mass index (BMI) was 28.7. All patients were symptomatic. Intraoperative findings included recurrent hiatal hernia in 47 (63%) patients, incompetent fundoplication in 14 (19%) patients, tight fundoplication in 8 (11%) patients, and tight crura in 2 (3%) patients. Laparoscopic Nissen fundoplication was performed in 57 (76%) patients, partial posterior fundoplication was performed in 12 (16%) patients, partial anterior fundoplication was performed in 3 (4%) patients, removal of crural stitches was performed in 2 patients, and a combination of partial posterior fundoplication and removal of crural stiches was performed in 1 patient. Complications occurred in 13 (15%) patients. Improvement in symptoms was observed in 70 (93%) patients in early postoperative follow-up and in 59 (78%) patients in long-term follow-up. Functional results were classified as excellent in 59 (78%) patients, good in 6 (7%) patients, fair in 7 (8%) patients, and poor in 3 (4%) patients.
Laparoscopic reoperation for failed antireflux operations is a complex procedure, but it is safe and effective in selected patients. Reoperation after a failed antireflux repair results in excellent or good functional status in a majority of patients, but these results may deteriorate over time.
微创手术已变得很常见，越来越多因抗反流手术失败而进行的再次手术采用腹腔镜方式进行。我们想要研究腹腔镜下反流再次手术的结果。
回顾了2000年1月至2012年10月期间所有在先前抗反流手术后未行食管切除术而接受再次手术的患者的病历。
本报告纳入了75例患者：56例（77%）为女性，19例（23%）为男性。中位年龄为58岁。65例（87%）患者先前的手术为腹腔镜抗反流手术。上次抗反流手术与腹腔镜再次手术之间的中位间隔时间为42个月。中位体重指数（BMI）为28.7。所有患者均有症状。术中发现包括47例（63%）患者存在复发性食管裂孔疝，14例（19%）患者胃底折叠术功能不全，8例（11%）患者胃底折叠术过紧，2例（3%）患者膈脚过紧。57例（76%）患者行腹腔镜nissen胃底折叠术，12例（16%）患者行部分后胃底折叠术，3例（4%）患者行部分前胃底折叠术，2例患者拆除膈脚缝线，1例患者行部分后胃底折叠术与拆除膈脚缝线联合手术。13例（15%）患者发生并发症。术后早期随访中70例（93%）患者症状改善，长期随访中59例（78%）患者症状改善。功能结果分类为：59例（78%）患者为优秀，6例（7%）患者为良好，7例（8%）患者为中等，3例（4%）患者为差。
腹腔镜下抗反流手术失败后的再次手术是一个复杂的手术，但在选定的患者中是安全有效的。抗反流修复失败后再次手术可使大多数患者获得优秀或良好的功能状态，但这些结果可能会随时间恶化。
