Robertson Jason O, Jarboe Marcus D
Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan , Ann Arbor, Michigan.
J Laparoendosc Adv Surg Tech A. 2018 Jan;28(1):95-100. doi: 10.1089/lap.2017.0257. Epub 2017 Oct 19.
Laparoscopic Nissen fundoplication (LNF) is the standard for surgical treatment of gastroesophageal reflux disease (GERD), but postoperative complications and pain are common in patients with severe neurological impairment (NI) and those undergoing reoperative procedures. Transoral incisionless fundoplication (TIF) is an endoscopic alternative to treat GERD. Long-term results in pediatric populations are unknown.
Eleven patients who underwent TIF between January 2008 and September 2010 were included. A retrospective chart review was performed to evaluate long-term patient outcomes. Median follow-up was 5.6 years (range = 0.42-8.76 years).
Average patient age was 16.5 ± 5.1 years. Severe NI was present in 81.8% (9/11) of patients, and 63.6% (7/11) had undergone one or more prior fundoplication attempts. Overall, symptomatic reflux recurred or persisted in 54.5% (6/11) of patients. Recurrent symptoms were more common among those who had previous fundoplications than those who did not (71.4% [5/7] vs. 25% [1/4]). Four patients went on to require reoperation, including one laparoscopic Nissen and three disconnects. At last follow-up, 81.8% (9/11) of patients were still on antireflux medications.
This is the first report of long-term outcomes for treatment of GERD using TIF in a pediatric population. The recurrence rate was high, likely related to the fact that the population treated was extremely high risk. Recurrence was higher in patients with a prior fundoplication, perhaps identifying prior antireflux operations as a relative contraindication to TIF. Nevertheless, complications were low, and a subset of patients did receive a durable benefit from the procedure.
腹腔镜Nissen胃底折叠术（LNF）是胃食管反流病（GERD）手术治疗的标准术式，但严重神经功能障碍（NI）患者及再次手术患者术后并发症和疼痛较为常见。经口无切口胃底折叠术（TIF）是治疗GERD的一种内镜替代方法。儿科人群的长期治疗效果尚不清楚。
纳入2008年1月至2010年9月期间接受TIF手术的11例患者。进行回顾性病历审查以评估患者的长期预后。中位随访时间为5.6年（范围为0.42 - 8.76年）。
患者平均年龄为16.5±5.1岁。81.8%（9/11）的患者存在严重NI，63.6%（7/11）的患者曾接受过一次或多次先前的胃底折叠术尝试。总体而言，54.5%（6/11）的患者出现症状性反流复发或持续存在。有既往胃底折叠术史的患者复发症状比无既往史的患者更常见（71.4%[5/7]对25%[1/4]）。4例患者最终需要再次手术，包括1例腹腔镜Nissen手术和3例分离手术。在最后一次随访时，81.8%（9/11）的患者仍在服用抗反流药物。
这是关于儿科人群使用TIF治疗GERD长期疗效的首份报告。复发率较高，可能与所治疗人群风险极高这一事实有关。有既往胃底折叠术史的患者复发率更高，这可能表明既往抗反流手术是TIF的相对禁忌证。尽管如此，并发症发生率较低，一部分患者确实从该手术中获得了持久益处。
