Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland.
Department of General Thoracic and Esophageal Surgery, Lung and Heart Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
World J Surg. 2021 May;45(5):1495-1502. doi: 10.1007/s00268-021-05954-3. Epub 2021 Jan 27.
We aim to shed light on long-term subjective outcomes after re-operations for failed fundoplication.
1809 patients were operated on for hiatal hernia and/or gastroesophageal reflux disease (GERD) at the Helsinki University Hospital between 2000 and 2017. 111 (6%) of these had undergone a re-operation for a failed antireflux operation. Overall, HRQoL was assessed in 89 patients at the latest follow-up using the generic 15D© instrument. The results were compared to a sample of the general population, weighted to reflect the age and gender distribution of patients. Disease-specific HRQoL was assessed using the GERD-HRQoL questionnaire. We studied variation in the overall HRQoL with respect to disease-specific HRQoL and known patients' parameters using univariate and multivariable linear regression models.
The median postoperative follow-up period was 9.3 years. All patients were operated on laparoscopically (6% conversion rate), and 87% were satisfied with the re-operation. Postoperative complications were minimal (5%). Twelve patients (11%) underwent a second re-operation. The median GERD-HRQoL score was nine. In multivariable analysis, four variables were independently associated with the 15D score, suggesting a decrease in the 15D score with increasing GERD-HRQoL score, increasing Charlson Comorbidity Index (CCI) and the presence of chronic pain syndrome (CPS) and depression.
Re-do LF is a safe procedure in experienced hands and may offer acceptable long-term alleviation in patients with recurring symptoms after antireflux surgery. Decreased HRQoL in the long run is related to recurring GERD and co-morbidities.
我们旨在阐明胃食管反流病（GERD）手术后再手术失败的长期主观结果。
2000 年至 2017 年间，在赫尔辛基大学医院对 1809 例食管裂孔疝和/或胃食管反流病（GERD）患者进行了手术。其中 111 例（6％）因抗反流手术失败而接受再手术。在最近的随访中，使用通用 15D©工具评估了 89 例患者的整体 HRQoL。将结果与一般人群样本进行了比较，并进行了加权处理，以反映患者的年龄和性别分布。使用 GERD-HRQoL 问卷评估疾病特异性 HRQoL。我们使用单变量和多变量线性回归模型研究了整体 HRQoL 与疾病特异性 HRQoL 和已知患者参数的变化。
中位术后随访时间为 9.3 年。所有患者均接受腹腔镜手术（转换率为 6％），87％对再手术感到满意。术后并发症很少（5％）。12 例患者（11％）再次接受手术。GERD-HRQoL 评分中位数为 9。多变量分析显示，有四个变量与 15D 评分独立相关，表明随着 GERD-HRQoL 评分的增加，15D 评分降低，Charlson 合并症指数（CCI）增加，存在慢性疼痛综合征（CPS）和抑郁症。
在经验丰富的医生手中，重新进行 LF 是一种安全的手术，可为抗反流手术后出现症状复发的患者提供可接受的长期缓解。长期 HRQoL 下降与 GERD 和合并症有关。
