General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy.
General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy.
Int J Surg. 2017 Feb;38:83-89. doi: 10.1016/j.ijsu.2016.12.072. Epub 2016 Dec 28.
Laparoscopic anti-reflux surgery has a failure rate of 10-20%. We aimed to investigate whether a modification of Nissen fundoplication (MNF) may improve patients' outcome and reduce failure rate.
MATERIALS & METHODS: We prospectively compared 40 consecutive patients with gastroesophageal reflux disease who underwent anti-reflux surgery: 20 Nissen fundoplication (NF) and 20 the MNF approach. Eight cases in the MNF group needed redo surgery. The MNF consisted in suturing the esophagus to the diaphragmatic crura on each side by means of 4 non-absorbable stitches and in fixing the upper stitch of the valve to diaphragm. In case of clearly weak crura, a reinforcement with Ultrapro mesh was used. All patients were assessed before and after surgery using validated symptoms and quality of life (GERD-HRQL) questionnaires, manometry and 24-h impedance-pH monitoring, endoscopy and barium-swallow.
Mortality and postoperative complications were nil. At a median follow-up of 36 months, no significant differences emerged between the MNF and NF group in terms of symptoms, GERD-HRQL scores, manometric findings, and impedance-pH features. Dysphagia was not reported by the MNF group, while it was quite common (20% vs.0%, p = ns) in the NF group. Anti-reflux surgery was successful in all patients in the MNF group, whereas two patients in the NF group presented a slipped wrap and one recurrent reflux; two of these cases required redo-surgery (10% vs. 0%, p = ns).
Our preliminary data demonstrated that the MNF is a safe and effective procedure. Further, it seems to reduce the failure rate associated to the surgical procedure.
腹腔镜抗反流手术的失败率为 10-20%。我们旨在研究尼森胃底折叠术（MNF）的改良是否可以改善患者的预后并降低失败率。
我们前瞻性比较了 40 例胃食管反流病患者，他们接受了抗反流手术：20 例尼森胃底折叠术（NF）和 20 例 MNF 方法。MNF 组中有 8 例需要再次手术。MNF 包括通过 4 个非吸收缝线将食管缝合到膈脚的每一侧，并将瓣的上缝线固定到膈膜上。如果膈脚明显薄弱，使用 Ultrapro 网片进行加固。所有患者在手术前后均使用经过验证的症状和生活质量（GERD-HRQL）问卷、测压和 24 小时阻抗-pH 监测、内镜和钡餐进行评估。
无死亡和术后并发症。在中位数为 36 个月的随访中，MNF 和 NF 组在症状、GERD-HRQL 评分、测压和阻抗-pH 特征方面没有显著差异。MNF 组无吞咽困难报告，而 NF 组则较为常见（20%比 0%，p=ns）。MNF 组所有患者的抗反流手术均成功，而 NF 组中有 2 例出现包裹滑脱，1 例复发反流；其中 2 例需要再次手术（10%比 0%，p=ns）。
我们的初步数据表明，MNF 是一种安全有效的手术方法。此外，它似乎降低了与手术相关的失败率。
