Gunter Rebecca L, Shada Amber L, Funk Luke M, Wang Xing, Greenberg Jacob A, Lidor Anne O
Department of Surgery, University of Wisconsin , Madison, Wisconsin.
J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):931-936. doi: 10.1089/lap.2017.0232. Epub 2017 Jul 24.
Laparoscopic fundoplication is the gold standard treatment for gastroesophageal reflux disease (GERD) refractory to medical management. Although many studies have compared Nissen fundoplication (NF) to Toupet fundoplication (TF), it is unclear which operation provides the best long-term reflux control. The objective of this study was to evaluate long-term quality-of-life (QoL) outcomes after NF versus TF.
Clinical data from our single academic institutional foregut database were used to identify patients who underwent NF or TF (June 2010 to May 2016). Postoperative QoL was assessed through telephone at 1, 3, or 5 years postsurgery, using GERD-health related quality of life (GERD-HRQL), Gastroparesis Cardinal Symptom Index (GCSI), and Eckardt Dysphagia scores. Proton pump inhibitor (PPI) use and satisfaction with surgery were also obtained. Trends in outcomes over time were analyzed by logistic regression or Cochran-Armitage trend test.
Our cohort included 155 TF and 161 NF patients. TF patients reported baseline dysphagia at higher rates (42.6% versus 19.9%; P < .001) and had worse preoperative esophageal dysmotility than NF patients. There were no significant differences in GERD-HRQL or GCSI scores between TF and NF patients at any time point postoperatively. Long-term satisfaction was equivalent between TF and NF patients 5 years postoperatively (70.0% versus 77.4%; P = .67). NF patients had higher Eckardt dysphagia scores 1 year after surgery compared to TF patients, but this difference was not present at 3 or 5 years postoperatively. Over time, PPI use increased and there was a trend toward increased GERD-HRQL scores in the TF group.
Both TF and NF provide excellent long-term satisfaction for patients with GERD. NF and TF patients reported similar postoperative QoL scores. Our finding of increasing PPI use and a trend toward worsening GERD scores following TF warrants additional investigation regarding the long-term durability of TF.
腹腔镜胃底折叠术是药物治疗无效的胃食管反流病（GERD）的金标准治疗方法。尽管许多研究已将nissen胃底折叠术（NF）与Toupet胃底折叠术（TF）进行了比较，但尚不清楚哪种手术能提供最佳的长期反流控制。本研究的目的是评估NF与TF术后的长期生活质量（QoL）结局。
使用我们单一学术机构的前肠数据库中的临床数据来识别接受NF或TF手术的患者（2010年6月至2016年5月）。术后1、3或5年通过电话使用GERD健康相关生活质量（GERD-HRQL）、胃轻瘫主要症状指数（GCSI）和Eckardt吞咽困难评分来评估生活质量。还获取了质子泵抑制剂（PPI）的使用情况和对手术的满意度。通过逻辑回归或 Cochr an-Armitage趋势检验分析结局随时间的变化趋势。
我们的队列包括155例TF患者和161例NF患者。TF患者基线吞咽困难发生率较高（42.6%对19.9%；P <.001），且术前食管动力比NF患者差。术后任何时间点，TF和NF患者的GERD-HRQL或GCSI评分均无显著差异。术后5年，TF和NF患者的长期满意度相当（70.0%对77.4%；P = 0.67）。与TF患者相比，NF患者术后1年的Eckardt吞咽困难评分更高，但术后3年和5年不存在这种差异。随着时间的推移，PPI的使用增加，TF组的GERD-HRQL评分有升高趋势。
TF和NF对GERD患者均提供了出色的长期满意度。NF和TF患者术后QoL评分相似。我们发现TF术后PPI使用增加且GERD评分有恶化趋势，这需要对TF的长期疗效进行进一步研究。
