Aye Ralph W, Baison George N, Ahmed Hassan, Watkins Jeffery, DeMeester Steven R, Bograd Adam J, Farivar Alexander S, Louie Brian E
Department of Thoracic and Foregut Surgery, Swedish Medical Center, Seattle, WA.
Department of General Surgery, Tufts Medical Center, Boston, MA.
Ann Surg. 2022 Oct 1;276(4):626-634. doi: 10.1097/SLA.0000000000005586. Epub 2022 Jul 15.
A new repair for gastroesophageal reflux and hiatal hernia, the Nissen-Hill hybrid repair, was developed to combine the relative strengths of its component repairs with the aim of improved durability. In several small series, it has been shown to be safe, effective, and durable for paraesophageal hernia, Barrett esophagus, and gastroesophageal reflux disease. This study represents our experience with the first 500 consecutive repairs for all indications.
Retrospective study of prospectively collected data for the first 500 consecutive Nissen-Hill hybrid repairs from March 2006 to December 2016, including all indications for surgery. Three quality of life metrics, manometry, radiographic imaging, and pH testing were administered before and at defined intervals after repair.
Five hundred patients were included, with a median follow-up of 6.1 years. Indications for surgery were gastroesophageal reflux disease in 231 (46.2%), paraesophageal hernia in 202 (40.4%), and reoperative repair in 67 (13.4%). The mean age was 59, with body mass index of 30 and 63% female. A minimally invasive approach was used in 492 (98%). Thirty-day operative mortality was 1 (0.2%), with a 4% major complication rate and a median length of stay of 2 days. Preoperative to postoperative pH testing was available for 390 patients at a median follow-up of 7.3 months, with the median DeMeester score improving from 45.9 to 2.7. At long-term follow-up (229 responses), all median quality of life scores improved: Quality Of Life in Reflux And Dyspepsia 4 to 6.9, Gastroesophageal Reflux Disease-Health Related Quality of Life 22 to 3, and Swallowing 37.5 to 45 and proton pump inhibitor use dropped from 460 (92%) to 50 (10%). Fourteen (2.8%) underwent reoperation for failure.
The combined Nissen-Hill hybrid repair is safe and effective in achieving excellent symptomatic and objective outcomes and low recurrence rates beyond 5 years.
一种用于治疗胃食管反流和食管裂孔疝的新型修复术——nissen-Hill混合修复术被研发出来，旨在结合其组成修复术的相对优势，以提高耐用性。在几个小系列研究中，已证明其对食管旁疝、巴雷特食管和胃食管反流病是安全、有效且持久的。本研究展示了我们对前500例连续进行的各种适应症修复术的经验。
对2006年3月至2016年12月连续进行的前500例nissen-Hill混合修复术的前瞻性收集数据进行回顾性研究，包括所有手术适应症。在修复术前及术后规定时间间隔进行三项生活质量指标、测压、影像学检查和pH值检测。
纳入500例患者，中位随访时间为6.1年。手术适应症包括胃食管反流病231例（46.2%）、食管旁疝202例（40.4%）、再次手术修复67例（13.4%）。平均年龄为59岁，体重指数为30，女性占63%。492例（98%）采用微创方法。30天手术死亡率为1例（0.2%），主要并发症发生率为4%，中位住院时间为2天。390例患者在中位随访7.3个月时可获得术前至术后的pH值检测结果，DeMeester评分中位数从45.9降至2.7。在长期随访（229例有回应）中，所有生活质量评分中位数均有所改善：反流和消化不良生活质量从4提高到6.9，胃食管反流病健康相关生活质量从22提高到3，吞咽评分从37.5提高到45，质子泵抑制剂的使用从460例（92%）降至50例（10%）。14例（2.8%）因手术失败接受再次手术。
nissen-Hill联合混合修复术在实现良好的症状和客观结果以及5年以上的低复发率方面是安全有效的。
