Department of Surgery, NorthShore University Health System, 2650 Ridge Avenue, GCSI Suite B665, Evanston, IL, 60201, USA.
Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
Surg Endosc. 2024 Sep;38(9):5350-5355. doi: 10.1007/s00464-024-11038-9. Epub 2024 Jul 19.
Numerous studies comment on quality of life outcomes comparing complete and partial fundoplication with or without a bougie. Society guidelines are moving toward recommending partial fundoplication over complete fundoplication due to improved side effect profile with similar outcomes. Retrospective studies and randomized trials have elucidated that use of a bougie during Nissen fundoplication does impact long-term dysphagia. To date there are no retrospective or prospective data that guide practice for partial fundoplications.
The purpose of this project is to investigate the clinical implications of using a bougie for Toupet fundoplication with regard to short-term and long-term dysphagia and need for further therapeutic interventions.
A retrospective review of a prospectively maintained gastroesophageal database was performed. Demographic, pre-operative quality of life outcomes data, perioperative, and post-operative quality of life outcomes data of 373 patients from 2011 to 2022 undergoing Toupet fundoplication without bougie or with a traditional Savary 56Fr or 58Fr bougie were reviewed. The two groups were compared using student's t-test to identify statically significant differences between the groups.
Between 2011 and 2022, 373 patients underwent Toupet fundoplication (276 with traditional bougie, 97 without). Median follow-up in the bougie group was 19 months, versus 9 months in the non bougie group. There was no difference between early (3 weeks) and late dysphagia scores (6 months). In the bougie group there were two mucosal perforations due to the bougie. There were no statistically significant differences in GERD-HRQL, gas bloat, and dysphagia scores between groups at one year.
There is no difference observed in early or late dysphagia scores, GERD-HRQL, gas bloat or need for dilation in patients undergoing Toupet fundoplication with or without a traditional bougie. It is reasonable to discontinue the use of a traditional bougie during Toupet fundoplication, especially due to risk of esophageal perforation.
许多研究都比较了完整和部分胃底折叠术与带或不带探条的效果，并对生活质量结果进行了评论。由于部分胃底折叠术具有更好的副作用特征和相似的效果，因此，社会指南正逐渐倾向于推荐使用部分胃底折叠术而非完整胃底折叠术。回顾性研究和随机试验已经阐明，在 Nissen 胃底折叠术中使用探条确实会影响长期吞咽困难。迄今为止，尚无关于指导部分胃底折叠术实践的回顾性或前瞻性数据。
本项目旨在研究 Toupet 胃底折叠术中使用探条对短期和长期吞咽困难以及进一步治疗干预的临床意义。
对 2011 年至 2022 年期间进行的 373 例 Toupet 胃底折叠术（无探条 276 例，有探条 97 例）的前瞻性胃食管数据库进行回顾性分析。比较两组患者的人口统计学、术前生活质量结局数据、围手术期和术后生活质量结局数据。使用学生 t 检验比较两组之间的统计学差异。
2011 年至 2022 年间，373 例患者接受了 Toupet 胃底折叠术（276 例使用传统探条，97 例未使用）。探条组的中位随访时间为 19 个月，无探条组为 9 个月。早期（3 周）和晚期（6 个月）吞咽困难评分无差异。在探条组中，有 2 例因探条导致黏膜穿孔。两组在 1 年时的 GERD-HRQL、气体膨胀和吞咽困难评分均无统计学差异。
在接受 Toupet 胃底折叠术的患者中，使用或不使用传统探条，早期或晚期吞咽困难评分、GERD-HRQL、气体膨胀或需要扩张之间无差异。因此，在进行 Toupet 胃底折叠术时，特别是由于食管穿孔的风险，停止使用传统探条是合理的。
