Analatos Apostolos, Lindblad Mats, Rouvelas Ioannis, Elbe Peter, Lundell Lars, Nilsson Magnus, Tsekrekos Andrianos, Tsai Jon A
Centre for Digestive Diseases, Karolinska University Hospital and Division of Surgery, Department of Clinical Intervention and Technology (CLINTEC), Karolinska Institutet, Stockhom, Sweden.
Department of Surgery, Nyköping Hospital, Nyköping, Sweden.
BMC Surg. 2018 Aug 30;18(1):70. doi: 10.1186/s12893-018-0401-8.
Primary antireflux surgery has high success rates but 5 to 20% of patients undergoing antireflux operations can experience recurrent reflux and dysphagia, requiring reoperation. Different surgical approaches after failed fundoplication have been described in the literature. The aim of this study was to evaluate resection of the gastroesophageal junction with jejunal interposition (Merendino procedure) as a rescue procedure after failed fundoplication.
All patients who underwent a Merendino procedure at the Karolinska University Hospital between 2004 and 2012 after a failed antireflux fundoplication were identified. Data regarding previous surgical history, preoperative workup, postoperative complications, subsequent investigations and re-interventions were collected retrospectively. The follow-up also included questionnaires regarding quality of life, gastrointestinal function and the dumping syndrome.
Twelve patients had a Merendino reconstruction. Ten patients had undergone at least two previous fundoplications, of which one patient had four such procedures. The main indication for surgery was epigastric and radiating back pain, with or without dysphagia. Postoperative complications occurred in 8/12 patients (67%). During a median follow-up of 35 months (range 20-61), four (25%) patients had an additional redo procedure with conversion to a Roux-en-Y esophagojejunostomy within 12 months, mainly due to obstructive symptoms that could not be managed conservatively or with endoscopic techniques. Questionnaires scores were generally poor in all dimensions.
In our experience, the Merendino procedure seems to be an unsuitable surgical option for patients who require an alternative surgical reconstruction due to a failed fundoplication. However, the small number of patients included in this study as well as the small number of participants who completed the postoperative workout limits this study.
原发性抗反流手术成功率较高，但接受抗反流手术的患者中有5%至20%会出现反流复发和吞咽困难，需要再次手术。文献中描述了胃底折叠术失败后的不同手术方法。本研究的目的是评估采用空肠间置术切除胃食管交界部（梅伦迪诺手术）作为胃底折叠术失败后的挽救手术。
确定2004年至2012年期间在卡罗林斯卡大学医院接受梅伦迪诺手术后胃底折叠术失败的所有患者。回顾性收集有关既往手术史、术前检查、术后并发症、后续检查和再次干预的数据。随访还包括关于生活质量、胃肠功能和倾倒综合征的问卷。
12例患者接受了梅伦迪诺重建术。10例患者此前至少接受过两次胃底折叠术，其中1例患者接受过4次此类手术。手术的主要指征是上腹部和放射性背痛，伴或不伴有吞咽困难。8/12例患者（67%）出现术后并发症。在中位随访35个月（范围20 - 61个月）期间，4例（25%）患者在12个月内再次进行了手术，改为Roux-en-Y食管空肠吻合术，主要原因是梗阻症状无法通过保守治疗或内镜技术处理。问卷各维度得分总体较差。
根据我们的经验，对于因胃底折叠术失败而需要进行替代手术重建的患者，梅伦迪诺手术似乎不是合适的手术选择。然而，本研究纳入的患者数量较少，以及完成术后检查的参与者数量较少，限制了本研究。
