Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Surg Endosc. 2022 May;36(5):3019-3027. doi: 10.1007/s00464-021-08598-5. Epub 2021 Jun 22.
Various technical modifications of Nissen fundoplication (NF) that aim to improve patients' outcomes have been discussed. This study aims to evaluate the effect of division of the short gastric vessels (SGV) and the addition of a standardized fundophrenicopexia on the postoperative outcome after NF.
283 consecutive patients with GERD treated with NF were divided into four groups following consecutive time periods: with division of the SGV and without fundophrenicopexia (group A), with division of the SGV and with fundophrenicopexia (group B), without division of the SGV and with fundophrenicopexia (group C) and without division of the SGV and without fundophrenicopexia (group D). Postoperative contrast swallow, dysphagia scoring, GEDR-HRQL and proton pump inhibitor intake were evaluated. A comparative analysis of patients with division of the SGV and those without (161 A + B vs. 122 C + D), and patients with fundophrenicopexia and those without (78 A vs. 83 B and 49 C vs. 73 D) was performed.
Fundophrenicopexia reduced postoperative dysphagia rates (0 group C vs. 5 group D, p = 0.021) in patients where the SGV were preserved and reoperation rates (1 group B vs. 7 group A, p = 0.017) in patients where the SGV were divided. There was no significant difference in the postoperative rates of heartburn relief, dysphagia, gas bloating syndrome, interventions, re-fundoplication and the GERD-HRQL score between groups A + B and C + D, respectively.
Standardized additional fundophrenicopexia in patients undergoing Nissen fundoplication significantly reduces postoperative dysphagia in patients without division of the SGV and reoperation rates in patients with division of the SGV. Division of the SGV has no influence on the postoperative outcome of NF.
已经讨论了各种旨在改善患者结果的尼森胃底折叠术（NF）技术修改。本研究旨在评估胃短血管（SGV）的分离和标准化膈胃固定术的添加对 NF 术后结果的影响。
283 例 GERD 患者连续接受 NF 治疗，分为四组：SGV 分离且无膈胃固定术（A 组）、SGV 分离且有膈胃固定术（B 组）、无 SGV 分离且有膈胃固定术（C 组）和无 SGV 分离且无膈胃固定术（D 组）。评估术后对比吞咽、吞咽困难评分、GEDR-HRQL 和质子泵抑制剂摄入量。对 SGV 分离的患者（161 A+B 与 122 C+D）和有膈胃固定术的患者（78 A 与 83 B 和 49 C 与 73 D）进行比较分析。
膈胃固定术降低了 SGV 保留患者的术后吞咽困难发生率（0 组 C 与 5 组 D，p=0.021）和 SGV 分离患者的再手术率（1 组 B 与 7 组 A，p=0.017）。在 A+B 组和 C+D 组之间，胃灼热缓解、吞咽困难、气体膨胀综合征、干预、再胃底折叠和 GERD-HRQL 评分的术后发生率均无显著差异。
在接受 NF 的患者中，标准化的附加膈胃固定术可显著降低 SGV 无分离患者的术后吞咽困难和 SGV 分离患者的再手术率。SGV 的分离对 NF 的术后结果没有影响。
