Zaninotto G, Molena D, Ancona E
Department of Medical and Surgical Sciences, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy, Italy.
Surg Endosc. 2000 Mar;14(3):282-288. doi: 10.1007/PL00021300.
A national survey was undertaken by the Italian Society for Laparoscopic Surgery to investigate the prevalence, indications, conversion rate, mortality, morbidity, and early results of laparoscopic antireflux surgery.
Beginning on January 1, 1996, all of the centers taking part in this study were asked to complete a questionnaire on each patient. The questionnaire was divided into four parts and covered such areas as indications for surgery and preoperative workup, type of operation performed and certain aspects of the surgical technique, conversions and their causes, intraoperative and postoperative complications (within 4 weeks), and details of the postoperative course. The last part of the questionnaire focused on the follow-up period and was designed to gather data on recurrence of preoperative symptoms, postoperative symptoms (dysphagia, gas bloat), and postoperative test findings.
As of June 30 1998, 21 centers were taking part in the study and 621 patients were enrolled, with a median of 27 patients per center (less than one patient/month). The most popular technique was the Nissen-Rossetti (52%), followed by the Nissen (33%) and Toupet procedures (13%). Other techniques, such as the Dor and Lortat-Jacob, were used in the remainder of cases. Patients who received a Toupet procedure had a higher incidence of defective peristalsis (p < 0.05). The conversion rate to open surgery was 2.9%. The most common causes of conversion were inability to reduce the hiatus hernia or distal esophagus in the abdomen and adhesions from previous surgery. Perforation of the stomach and esophagus occurred in <1% of patients. Mortality was nil. Postoperative complications were observed in 7.3% of cases. The most common complication was acute dysphagia (19 patients), which required reoperation in 10 patients. No differences in the incidence of acute dysphagia were found for the different surgical techniques employed. Follow-up data were obtained for 319 patients (53%): 91.5% of the patients remained GERD symptom-free; severe esophagitis (grade 2-3) healed in 95% of the patients; lower esophageal sphincter (LES) manometric characteristics (pressure, abdominal length, and overall length) improved significantly after surgery (p < 0.005); and acid exposure of the distal esophagus decreased.
Laparoscopic antireflux surgery has no mortality and a low morbidity. Symptoms and esophagitis are resolved in >90% of patients. Despite these favorable results, however, this type of surgery is not yet as widely employed in Italy as in other countries.
意大利腹腔镜外科学会开展了一项全国性调查，以研究腹腔镜抗反流手术的患病率、适应证、中转率、死亡率、发病率及早期疗效。
从1996年1月1日起，要求所有参与本研究的中心填写一份关于每位患者的问卷。问卷分为四个部分，涵盖手术适应证及术前检查、所施行的手术类型及手术技术的某些方面、中转情况及其原因、术中和术后并发症（4周内）以及术后病程细节。问卷的最后一部分聚焦随访期，旨在收集术前症状复发、术后症状（吞咽困难、气体潴留）及术后检查结果的数据。
截至1998年6月30日，有21个中心参与研究，共纳入621例患者，每个中心的患者中位数为27例（每月不到1例）。最常用的技术是nissen - rossetti术（52%），其次是nissen术（33%）和Toupet手术（13%）。其余病例采用其他技术，如Dor术和Lortat - Jacob术。接受Toupet手术的患者蠕动功能不良的发生率较高（p < 0.05）。中转开腹手术的比例为2.9%。最常见的中转原因是无法将食管裂孔疝或远端食管还纳至腹腔以及既往手术导致的粘连。胃和食管穿孔的发生率<1%。无死亡病例。7.3%的病例观察到术后并发症。最常见的并发症是急性吞咽困难（19例患者），其中10例患者需要再次手术。不同手术技术的急性吞咽困难发生率无差异。获得了319例患者（53%）的随访数据：91.5%的患者反流性食管炎症状消失；95%的患者重度食管炎（2 - 3级）愈合；术后食管下括约肌（LES）测压特征（压力、腹段长度和总长度）显著改善（p < 0.005）；远端食管的酸暴露减少。
腹腔镜抗反流手术无死亡率，发病率低。超过90%的患者症状和食管炎得到缓解。然而，尽管有这些良好结果，但这种手术在意大利的应用不如其他国家广泛。
