Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
J Gastrointest Surg. 2021 Nov;25(11):2750-2756. doi: 10.1007/s11605-021-04930-5. Epub 2021 Feb 2.
Postoperative dysphagia after anti-reflux surgery typically resolves in a few weeks. However, even after the initial swelling has resolved at 6 weeks, dysphagia can persist in 30% of patients necessitating esophageal dilation. The purpose of this study was to investigate the effect of esophageal dilation on postoperative dysphagia, the recurrence of reflux symptoms, and the efficacy of pneumatic dilations on postoperative dysphagia.
A prospectively collected database was reviewed for patients who underwent partial/complete fundoplication with/without paraesophageal hernia repair between 2006 and 2014. Patient age, sex, BMI, DeMeester score, procedure type, procedure duration, length of stay, postoperative dysphagia, time to first pneumatic dilation, number of dilations, and the need for reoperations were collected.
The study included 902 consecutive patients, 71.3% females, with a mean age of 57.8 ± 14.7 years. Postoperative dysphagia was noted in 26.3% of patients, of whom 89% had complete fundoplication (p < 0.01). Endoscopic dilation was performed in 93 patients (10.3%) with 59 (63.4%) demonstrating persistent dysphagia. Recurrent reflux symptoms occurred in 35 (37.6%) patients who underwent endoscopic dilation. Patients who underwent a dilation for symptoms of dysphagia were less likely to require a revisional surgery later than patients who had dysphagia but did not undergo a dilation before revisional surgery (17.2% vs 41.7%, respectively, p < 0.001) in the 4-year follow-up period. The duration of initial dilation from surgery was inversely related to the need for revisional surgery (p = 0.047), while more than one dilation was not associated with additive benefit.
One attempt at endoscopic dilation of the esophagogastric fundoplication may provide relief in patients with postoperative dysphagia and can be used as a predictive factor for the need of revision. However, there is an increased risk for recurrent reflux symptoms and revisional surgery may ultimately be indicated for control of symptoms.
抗反流手术后的吞咽困难通常在几周内得到缓解。然而，即使在术后 6 周初始肿胀消退后，仍有 30%的患者持续存在吞咽困难，需要进行食管扩张。本研究旨在探讨食管扩张对术后吞咽困难、反流症状复发的影响，以及气动扩张对术后吞咽困难的疗效。
回顾性收集了 2006 年至 2014 年间行部分/完全胃底折叠术加/不加食管裂孔疝修补术的患者的前瞻性数据库。收集患者的年龄、性别、BMI、DeMeester 评分、手术类型、手术时间、住院时间、术后吞咽困难、首次行气动扩张的时间、扩张次数以及再次手术的需要。
本研究共纳入 902 例连续患者，女性占 71.3%，平均年龄为 57.8 ± 14.7 岁。术后吞咽困难发生率为 26.3%，其中 89%行完全胃底折叠术（p < 0.01）。93 例（10.3%）患者行内镜下扩张，其中 59 例（63.4%）患者吞咽困难持续存在。内镜下扩张后有 35 例（37.6%）患者出现反流症状复发。对于因吞咽困难而行扩张的患者，与未行扩张而直接行再次手术的患者相比，在 4 年随访期间，需要再次手术的可能性更小（分别为 17.2%和 41.7%，p < 0.001）。首次扩张与手术的时间间隔与再次手术的需要呈反比（p = 0.047），而多次扩张并不能带来额外的获益。
对于术后吞咽困难患者，行一次内镜下胃底折叠术扩张可能有助于缓解症状，并可作为再次手术需要的预测因素。然而，存在反流症状复发的风险增加，最终可能需要再次手术以控制症状。
