Maret-Ouda John, Lagergren Jesper
Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Cancer Studies, Gastrointestinal Cancer, King's College London, UK.
Am J Surg. 2017 Jun;213(6):1160-1162. doi: 10.1016/j.amjsurg.2016.09.034. Epub 2016 Sep 30.
Mortality following laparoscopic fundoplication has been found to be negligible. However, some patients require secondary fundoplication, and the risk of mortality following such procedure is scarcely studied.
This nationwide Swedish population-based cohort study included all patients undergoing secondary fundoplication following primary laparoscopic fundoplication in 1997 to 2013, regardless of indication. Primary outcome was mortality within 90 days of surgery, and secondary outcome was postoperative length of hospital stay.
A total of 9,765 patients underwent primary laparoscopic fundoplication, 540 (5.5%) patients underwent secondary fundoplication. About 382 (70.7%) were conducted laparoscopically, and 158 (29.3%) were conducted with an open technique. No deaths occurred within 90 days of the secondary fundoplication. Median length of stay was longer following secondary fundoplication (4.8 days, interquartile range 1.0 to 5.0 days), compared to primary laparoscopic fundoplication (2.5 days, interquartile range 1.0 to 3.0 days).
This population-based cohort study indicates that secondary fundoplication following primary laparoscopic fundoplication is a safe procedure. The longer hospital stay following secondary fundoplication compared to primary laparoscopic fundoplication is likely explained by the higher rate of open surgical approach.
腹腔镜胃底折叠术术后死亡率已被发现可忽略不计。然而，一些患者需要二次胃底折叠术，而此类手术的死亡率风险几乎未被研究。
这项基于瑞典全国人群的队列研究纳入了1997年至2013年所有在初次腹腔镜胃底折叠术后接受二次胃底折叠术的患者，无论其手术指征如何。主要结局是术后90天内的死亡率，次要结局是术后住院时间。
共有9765例患者接受了初次腹腔镜胃底折叠术，540例（5.5%）患者接受了二次胃底折叠术。其中约382例（70.7%）采用腹腔镜手术，158例（29.3%）采用开放手术技术。二次胃底折叠术后90天内无死亡病例。与初次腹腔镜胃底折叠术（2.5天，四分位间距1.0至3.0天）相比，二次胃底折叠术后的中位住院时间更长（4.8天，四分位间距1.0至5.0天）。
这项基于人群的队列研究表明，初次腹腔镜胃底折叠术后的二次胃底折叠术是一种安全的手术。与初次腹腔镜胃底折叠术相比，二次胃底折叠术后住院时间更长可能是由于开放手术入路的比例更高。
