Keck Hospital of USC, Los Angeles, CA, USA.
Klinik Beau-Site Bern, Berne, Switzerland.
Surg Endosc. 2018 Jul;32(7):3374-3379. doi: 10.1007/s00464-018-6059-6. Epub 2018 Jan 16.
We have previously reported short-term outcomes after hiatal hernia repair (HHR) at the time of magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease (GERD). Here we report intermediate-term outcomes and hernia recurrence rate after concomitant MSA and HHR.
This is a retrospective cohort study of patients who underwent repair of a hiatal hernia 3 cm or larger at the time of MSA implantation between May 2009 and December 2015. The primary endpoint was hiatal hernia recurrence identified by routine postoperative videoesophagography or endoscopy. Recurrence was defined by a 2 cm or greater upward displacement of the stomach through the diaphragmatic esophageal hiatus. Secondary endpoints included cessation of proton-pump inhibitor (PPI), persistent dysphagia requiring intervention, and GERD health-related quality-of-life (HRQL) scores 1 year from surgery.
During the study period, 47 of 53 (89%) patients underwent concomitant MSA with HHR and complied with surveillance. Hiatal hernias ranged from 3 to 7 cm (mean 4 ± 1). Mean clinical follow-up time was 19 months (range 1-39). GERD-HRQL score decreased from 20.3 to 3.1 (p < .001), 89% of patients remained off PPIs, and 97% of patients reported improvement or resolution of symptoms. Two recurrent hiatal hernias were identified on surveillance imaging for a recurrence rate of 4.3% at a mean 18 (± 10) months after initial operation. Persistent dysphagia occurred in 13% (6/47) over the first year, which resolved after a single balloon dilation in 67% (4/6). Two patients elected for device removal due to dilation-refractory dysphagia and persistent reflux symptoms.
Concomitant magnetic sphincter augmentation and hiatal hernia repair in patients with gastroesophageal reflux disease and a moderate-sized hiatal hernia demonstrates durable subjective reflux control and an acceptable hiatal hernia recurrence rate at 1- to 2-year follow-up.
我们之前报道过胃食管反流病（GERD）患者行磁括约肌增强术（MSA）时同时行食管裂孔疝修补术（HHR）的短期结果。在此，我们报告了 MSA 和 HHR 同时进行的中期结果和疝复发率。
这是一项回顾性队列研究，纳入了 2009 年 5 月至 2015 年 12 月期间行 MSA 植入术且裂孔疝大于或等于 3cm 的患者。主要终点是通过常规术后食管录像或内镜检查发现的食管裂孔疝复发。复发定义为胃通过膈食管裂孔向上移动 2cm 或以上。次要终点包括质子泵抑制剂（PPI）停药、需要干预的持续性吞咽困难以及手术 1 年后 GERD 健康相关生活质量（HRQL）评分。
研究期间，53 例患者中有 47 例（89%）行 MSA 联合 HHR 治疗并接受了随访。裂孔疝大小为 3-7cm（平均 4±1cm）。平均临床随访时间为 19 个月（范围 1-39 个月）。GERD-HRQL 评分从 20.3 降至 3.1（p<0.001），89%的患者停止使用 PPI，97%的患者报告症状改善或缓解。2 例患者在初始手术后 18（±10）个月的随访影像学检查中发现复发疝，复发率为 4.3%。最初 1 年内有 13%（6/47）的患者出现持续性吞咽困难，67%（4/6）的患者经单次球囊扩张后缓解。2 例患者因扩张后吞咽困难和持续性反流症状而选择取出设备。
胃食管反流病和中等大小食管裂孔疝患者行 MSA 联合 HHR 治疗，术后 1-2 年具有持久的主观反流控制和可接受的食管裂孔疝复发率。
