Toomey Paul, Teta Anthony, Patel Krishen, Ross Sharona, Sukharamwala Prashant, Rosemurgy Alexander S
Florida Hospital Tampa, Tampa, Florida, USA.
Am Surg. 2014 Sep;80(9):860-7.
Transoral incisionless fundoplication (TIF) was U.S. Food and Drug Administration-approved in 2007 to treat gastroesophageal reflux disease (GERD), but comparative data are lacking. This study was undertaken to compare outcomes for patients with GERD undergoing TIF versus laparoscopic Nissen or Toupet fundoplications. We undertook a case-controlled study of three cohorts of 20 patients undergoing TIF or laparoscopic Nissen or Toupet fundoplications from 2010 to 2013 controlling for age, body mass index, and preoperative DeMeester scores. All patients were prospectively followed. Median data are reported. Patients undergoing TIF had significantly shorter operative times (in minutes: 71 vs 119 and 85, respectively, P < 0.001) and length of stay (in days: 1, 2, and 1, respectively, P < 0.001). No matter the approach, patients reported dramatic and similar reduction in symptom frequency and severity (e.g., heartburn 8 to 0, P < 0.05). At follow-up, 83 per cent of patients after TIF, 80 per cent after Nissen, or 92 per cent after Toupet fundoplications had symptoms less than once per month (P = 0.12). TIF leads to dramatic symptom resolution, similar when compared with Nissen or Toupet fundoplications. TIF promotes shorter operative times and lengths of stay. Patient satisfaction and effective palliation of symptoms show that TIF is safe and efficacious in comparison to Nissen and Toupet fundoplications and support its continued application and evaluation.
经口无切口胃底折叠术（TIF）于2007年获得美国食品药品监督管理局批准用于治疗胃食管反流病（GERD），但缺乏对比数据。本研究旨在比较接受TIF治疗的GERD患者与接受腹腔镜Nissen或Toupet胃底折叠术患者的治疗效果。我们进行了一项病例对照研究，对2010年至2013年期间三组各20例接受TIF或腹腔镜Nissen或Toupet胃底折叠术的患者进行研究，控制年龄、体重指数和术前DeMeester评分。所有患者均进行前瞻性随访。报告中位数数据。接受TIF治疗的患者手术时间显著更短（分别为71分钟、119分钟和85分钟，P<0.001），住院时间也显著更短（分别为1天、2天和1天，P<0.001）。无论采用何种手术方式，患者报告症状频率和严重程度均显著且相似地降低（例如，烧心从8分降至0分，P<0.05）。在随访中，TIF术后83%的患者、Nissen术后80%的患者或Toupet胃底折叠术后92%的患者症状每月少于一次（P = 0.12）。TIF能显著缓解症状，与Nissen或Toupet胃底折叠术相比效果相似。TIF可缩短手术时间和住院时间。患者满意度和症状的有效缓解表明，与Nissen和Toupet胃底折叠术相比，TIF安全有效，支持其继续应用和评估。
