Department of General Surgery, Danylo Halytsky Lviv National Medical University, Lviv.
Whiston Hospital, England, UK.
Surg Laparosc Endosc Percutan Tech. 2021 Jun 29;31(6):663-668. doi: 10.1097/SLE.0000000000000965.
Different techniques of wrap fixation in laparoscopic Nissen fundoplication (LNF) have been proposed with of the aim to reduce the complications, but the optimal technique is yet to be determined. The aim of our prospective study was to evaluate several techniques of wrap fixation and determine whether the application of a combined approach to perform wrap fixation reduces the failure rate in short-term and long-term follow-up.
One hundred two patients with sliding or paraesophageal hiatal hernia (type I or type II), who underwent antireflux surgery were randomized into 2 groups. In group I, LNF was supplemented with suturing the wrap to the diaphragmatic crura (35 patients) or to the body of stomach (16 patients). This was dependent on the strength of the crura (defined as weak or strong). The control group (51 patients) underwent LNF without wrap fixation. All patients were assessed using a validated symptom and quality of life (gastroesophageal reflux disease-Health Related Quality of Life) questionnaire, 24-hour impedance-pH monitoring, and barium swallow.
At the 48-month follow-up, the overall rate of complications was not significantly different between the 2 groups; however, there was a tendency toward a lower frequency of reoperations in the first group (P=0.059). Fixation of the fundoplication of wrap was noted to lead to significantly lower rates of postoperative dysphagia (P<0.05). These patients (group I) were also found to have significant improvement in gastroesophageal reflux disease-Health Related Quality of Life score (from 19.3±13.2 to 4.3±3.9 vs. from 18.7±11.9 to 9.3±7.7).
Fixation of the Nissen fundoplication wrap has been shown to have a positive impact on the reduction of postoperative dysphagia and leads to an improvement in disease-specific quality of life.
为了减少腹腔镜 Nissen 胃底折叠术（LNF）的并发症，已经提出了不同的包裹固定技术，但最佳技术仍有待确定。我们的前瞻性研究旨在评估几种包裹固定技术，并确定是否应用综合方法进行包裹固定可以降低短期和长期随访中的失败率。
102 例滑动性或食管旁食管裂孔疝（I 型或 II 型）患者随机分为 2 组。在 I 组中，LNF 中包裹的缝线固定于膈肌脚（35 例）或胃体（16 例），这取决于膈肌脚的强度（定义为弱或强）。对照组（51 例）行 LNF 但不进行包裹固定。所有患者均使用经过验证的症状和生活质量（胃食管反流病相关生活质量）问卷、24 小时阻抗-pH 监测和钡餐进行评估。
在 48 个月的随访中，两组患者的总体并发症发生率无显著差异；然而，第一组的再手术频率有降低的趋势（P=0.059）。包裹固定术可显著降低术后吞咽困难的发生率（P<0.05）。这些患者（I 组）的胃食管反流病相关生活质量评分也有显著改善（从 19.3±13.2 分降至 4.3±3.9 分，从 18.7±11.9 分降至 9.3±7.7 分）。
Nissen 胃底折叠术包裹固定术可减少术后吞咽困难，提高疾病特异性生活质量。
