Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medical Center, Chicago, IL.
Northwestern, Evanston, IL.
Surgery. 2023 Mar;173(3):710-717. doi: 10.1016/j.surg.2022.07.039. Epub 2022 Oct 26.
Laparoscopic fundoplication is the gold-standard surgical management for gastroesophageal reflux disease. Optimal patient outcomes include resolution of symptoms with minimal postoperative side effects of dysphagia or gas-bloat. This study aims to review outcomes at a single institution up to 10 years after surgery.
This is a retrospective review of a prospectively maintained quality database. Patients who underwent laparoscopic fundoplication from 2009 to 2021 were included. Transition in surgical practice mid-2017 with incorporation of fundoplication algorithm and impedance planimetry. Patient-reported outcome scores include Reflux Symptom Index, gastroesophageal reflux disease-health-related quality of life, and dysphagia score. Comparisons were made using two-tailed Wilcoxon rank sum tests.
Six hundred forty-five patients underwent laparoscopic fundoplication (2009-July 2017 n = 355, July 2017-November 2021 n = 290) from January 2009 to November 2021. Patients had an improvement in patient-reported outcomes and did not worsen from 2 to 10 years after surgery. Comparison of each time period showed that the second time period had fewer gas-bloat symptoms at 2 years (P = .04). Paraesophageal hernia was present in 66% of patients. Preoperative patient-reported outcomes in non-paraesophageal hernia include worse Reflux Symptoms Index (P < .01) and gastroesophageal reflux disease-health-related quality of life (P < .01) than the paraesophageal hernia group. Patient-reported outcomes were similar between the 2 except for worse gas-bloat in non-paraesophageal hernia patients at 2 years (P = .02). Endoscopy was performed in 10.9% (n = 58) of the study population at a median of 16 months, with 1.5% of patients (n = 8) from the entire cohort with abnormal DeMeester Scores. Median (interquartile range) preoperative DeMeester Score of 31 (17-51) decreased to 5 (2-14) at postoperative evaluation.
This single-institution study reports excellent long-term patient-reported outcomes after laparoscopic fundoplication that persist up to 10 years.
腹腔镜胃底折叠术是胃食管反流病的金标准手术治疗方法。最佳的患者治疗效果包括症状缓解，且术后吞咽困难或气胀等副作用最小。本研究旨在回顾单中心术后 10 年的治疗效果。
这是一项前瞻性维护质量数据库的回顾性研究。纳入 2009 年至 2021 年接受腹腔镜胃底折叠术的患者。2017 年年中手术实践发生转变，纳入胃底折叠术算法和阻抗平面图。患者报告的结果评分包括反流症状指数、胃食管反流病健康相关生活质量和吞咽困难评分。使用双侧 Wilcoxon 秩和检验进行比较。
645 例患者于 2009 年 1 月至 2021 年 11 月接受了腹腔镜胃底折叠术（2009 年 7 月至 2017 年 7 月 n=355，2017 年 7 月至 2021 年 11 月 n=290）。患者的治疗效果从术后 2 年到 10 年都有改善，且没有恶化。比较每个时间段发现，第二个时间段在术后 2 年的气胀症状更少（P=0.04）。66%的患者存在食管旁疝。非食管旁疝患者的术前患者报告结果包括反流症状指数（P<.01）和胃食管反流病健康相关生活质量（P<.01）更差，而非食管旁疝组。除了非食管旁疝患者在术后 2 年的气胀更严重外（P=0.02），两组患者的治疗效果相似。研究人群中有 10.9%（n=58）接受了内镜检查，中位数为 16 个月，整个队列中有 1.5%（n=8）的患者存在异常的 DeMeester 评分。术前中位数（四分位距）DeMeester 评分为 31（17-51），术后评估降至 5（2-14）。
这项单中心研究报告了腹腔镜胃底折叠术的优秀长期患者报告结果，这些结果在术后 10 年内仍然持续。
