Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Surg Endosc. 2021 Jan;35(1):298-302. doi: 10.1007/s00464-020-07396-9. Epub 2020 Feb 3.
Laparoscopic fundoplication is the current gold standard for medically refractory gastroesophageal reflux disease. Over a 10-year period following surgery, 5-10% of primary laparoscopic fundoplication patients undergo reoperative surgery. Our objective was to compare the symptomatic outcomes and morbidity of primary and reoperative fundoplication procedures.
This was a retrospective review of patients who underwent laparoscopic primary or reoperative fundoplication between 2011 and 2017. A single surgeon with a more than 10-year experience in reoperative foregut surgery performed all procedures. Patients in both groups completed the GERD health-related quality of life (GERD-HRQL) survey prior to surgery and postoperatively. Outcomes were reflected by the composite GERD-HRQL scores (0 to 50, with lower scores representing a better GERD-related quality of life), which were compared between groups postoperatively. Demographics, perioperative data, and complications were compared. Patient data were analyzed using Chi-Square tests and outcomes were analyzed using independent samples t tests and Mann-Whitney U tests.
There were 136 primary and 82 reoperative fundoplications. Prior to surgery, GERD-HRQL scores were similar for primary and reoperative patients. Both groups experienced significant improvement in GERD-related quality of life at 2 years, although this improvement was greater in primary patients (8.7 ± 7.8 primary vs. 14.3 ± 13.6 reoperative, p = 0.02). Operative time and length of stay were longer following reoperative cases. The rate of moderate to severe 30-day complications requiring radiologic, endoscopic, or surgical intervention was similar (2.9% primary vs. 1.2% reoperative, p = 0.65).
Patients who undergo reoperative fundoplication experience a significant improvement in their GERD-related symptoms, although not to the degree seen in primary antireflux surgery patients. Perioperative morbidity rates following reoperative and primary procedures can be similar in the hands of an experienced surgeon.
腹腔镜胃底折叠术是目前治疗药物难治性胃食管反流病的金标准。在手术后的 10 年内，5-10%的初次腹腔镜胃底折叠术患者需要再次手术。我们的目的是比较初次和再次胃底折叠术的症状结果和发病率。
这是一项回顾性研究，纳入 2011 年至 2017 年间接受初次或再次腹腔镜胃底折叠术的患者。所有手术均由一位具有 10 年以上再次上消化道手术经验的外科医生完成。两组患者在手术前和手术后均完成胃食管反流病健康相关生活质量（GERD-HRQL）问卷调查。通过复合 GERD-HRQL 评分（0 至 50，分数越低表示 GERD 相关生活质量越好）来反映结果，并在手术后进行组间比较。比较两组患者的人口统计学、围手术期数据和并发症。使用卡方检验比较患者数据，使用独立样本 t 检验和曼-惠特尼 U 检验分析结果。
初次胃底折叠术 136 例，再次胃底折叠术 82 例。手术前，初次和再次胃底折叠术患者的 GERD-HRQL 评分相似。两组患者的 GERD 相关生活质量在 2 年时均显著改善，但初次胃底折叠术患者的改善程度更大（8.7±7.8 分 vs. 14.3±13.6 分，p=0.02）。再次胃底折叠术的手术时间和住院时间更长。需要放射、内镜或手术干预的中重度 30 天并发症发生率相似（初次胃底折叠术为 2.9%，再次胃底折叠术为 1.2%，p=0.65）。
再次胃底折叠术患者的 GERD 相关症状有显著改善，但程度不如初次抗反流手术患者。在有经验的外科医生手中，再次和初次手术的围手术期发病率可以相似。
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