Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.
Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina.
Surg Endosc. 2018 Aug;32(8):3675-3682. doi: 10.1007/s00464-018-6102-7. Epub 2018 Feb 12.
Gastroesophageal reflux disease (GERD), paraesophageal hernia (PEH), and achalasia are the most frequent benign esophageal disorders that may need surgical treatment. We aimed to identify risk factors for postoperative complications and to characterize trends of morbidity for surgery for benign esophageal disorders in a national cohort.
A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2013. Adult patients (≥ 18 years old) diagnosed with GERD, PEH, and achalasia, and who underwent fundoplication, PEH repair, and esophagomyotomy were included. The yearly incidence of complications, stratified by procedure, was calculated using Poisson regression, and multivariable logistic regression was used to determine risk factors for complications.
A total of 79,622 patients were included; 38,695 (48.6%) underwent PEH repair, 38,719 (48.6%) fundoplication, and 2208 (2.8%) esophagomyotomy. While the rate of postoperative complications dropped from 26.5 to 10.0% and from 16.1 to 12.2% for PEH repair and esophagomyotomy, respectively, the complication rate after fundoplication increased from 5.7 to 12.7% during the same period (p < 0.0001). Age, black race, diabetes, renal insufficiency, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, and open surgery were independent risk factors for postoperative complications. The rate of laparoscopic procedures for PEH repair increased from 4.9 to 91.4%, while for fundoplication it increased from 24.2 to 78.3% (p < 0.0001).
Opposite to PEH repair and esophagomyotomy, antireflux surgery has shown an increase in the morbidity rate in the last decade. Patient selection and embracement of laparoscopic techniques are critical to improve the perioperative outcome in surgery for benign esophageal disorders.
胃食管反流病（GERD）、食管裂孔疝（PEH）和贲门失弛缓症是最常见的良性食管疾病，可能需要手术治疗。我们旨在确定术后并发症的危险因素，并在全国队列中描述良性食管疾病手术发病率的趋势。
使用国家住院患者样本（2000-2013 年）进行回顾性基于人群的分析。纳入诊断为 GERD、PEH 和贲门失弛缓症并接受胃底折叠术、PEH 修复术和食管肌切开术的成年患者（≥18 岁）。使用泊松回归计算按手术分层的并发症年发生率，并使用多变量逻辑回归确定并发症的危险因素。
共纳入 79622 例患者；38695 例（48.6%）行 PEH 修复术，38719 例（48.6%）行胃底折叠术，2208 例（2.8%）行食管肌切开术。尽管 PEH 修复术和食管肌切开术的术后并发症发生率从 26.5%降至 10.0%和从 16.1%降至 12.2%，但同期胃底折叠术的并发症发生率从 5.7%升至 12.7%（p<0.0001）。年龄、黑种人、糖尿病、肾功能不全、冠状动脉疾病、外周血管疾病、慢性阻塞性肺疾病和开放性手术是术后并发症的独立危险因素。PEH 修复术的腹腔镜手术比例从 4.9%升至 91.4%，而胃底折叠术的腹腔镜手术比例从 24.2%升至 78.3%（p<0.0001）。
与 PEH 修复术和食管肌切开术相反，抗反流手术在过去十年中显示出发病率的上升。患者选择和接受腹腔镜技术对于改善良性食管疾病手术的围手术期结果至关重要。
