Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University, 395 W 12th Ave Suite 670, Columbus, OH, 43210, USA.
Division of Trauma, Critical Care and Burn, Department of Surgery, The Ohio State University, Columbus, OH, USA.
Surg Endosc. 2024 Nov;38(11):6793-6799. doi: 10.1007/s00464-024-11176-0. Epub 2024 Aug 19.
Historically, DeMeester score over 14.7 has been used to diagnose GERD. The 2022 American Gastroenterological Association clinical guidelines define GERD based on acid exposure time (AET) instead of DeMeester score. We aim to compare outcomes after laparoscopic Nissen fundoplication (LNF) in patients based on differing GERD diagnostic criteria.
Patients who underwent first-time LNF between 2009 and 2017 were identified. Demographics, objective GERD evaluation, and outcomes were maintained in an IRB-approved database. Disease-specific quality of life was assessed with a survey (GERD-HRQL) with higher values representing more symptomatic disease. Descriptive statistics, Fischer's exact test and logistic regression were used to analyze the data, p-value < 0.05.
225 patients were stratified into two groups: borderline GERD (AET 4-6%, n = 25.11%) and GERD (AET ≥ 6%, n = 200.89%). The mean age was 50.1 ± 13.4 years and 169 (75%) were female. Baseline GERD-HRQL was lower in the borderline group (24.3 vs 30.0, p = 0.031). Short-term (5 weeks [IQR 4, 8]), medium-term (14 months [IQR 7.25, 31]) and long-term (6.75 years [IQR 5.5, 8]) follow-up was performed. GERD-HRQL scores did not differ between borderline and GERD patients at short-(6.0 vs 7.1, p = 0.630), medium-(12.0 vs 12.1, p = 0.818), or long-term follow-up (10.0 vs 9.0, p = 0.757). The absolute long-term improvement in GERD-HRQL was -12.3 (p = 0.022) vs. -21.3 (p < 0.001). At long-term follow-up there was no difference in PPI use (50% vs 47%, p = 0.852), satisfaction (58% vs 76%, p = 0.187), willingness to repeat the procedure given the benefit of hindsight (75% vs 85%, p = 0.386), or need for reoperation (14% vs 13%, p = 0.910).
Both patients with borderline GERD and GERD achieve GERD-HRQL improvements at 7 years following laparoscopic Nissen fundoplication and demonstrate similar long-term PPI usage and satisfaction with surgical results. Borderline GERD patients have lower GERD-HRQL at baseline, and thus have smaller improvements in their QOL scores. Anti-reflux surgery should be considered for patients with a diagnosis of borderline GERD refractory to medical therapy.
历史上，DeMeester 评分超过 14.7 被用于诊断 GERD。2022 年美国胃肠病学会临床指南基于酸暴露时间（AET）而非 DeMeester 评分来定义 GERD。我们旨在比较基于不同 GERD 诊断标准的腹腔镜 Nissen 胃底折叠术（LNF）后患者的结局。
确定了 2009 年至 2017 年间首次接受 LNF 的患者。在经过机构审查委员会批准的数据库中维护患者的人口统计学、客观 GERD 评估和结局。使用问卷调查（GERD-HRQL）评估疾病特异性生活质量，得分越高表示症状越严重。使用描述性统计、Fisher 确切检验和逻辑回归分析数据，p 值<0.05。
225 名患者被分为两组：边缘性 GERD（AET 4-6%，n=25.11%）和 GERD（AET≥6%，n=200.89%）。平均年龄为 50.1±13.4 岁，169 名（75%）为女性。基线时边缘性 GERD 组的 GERD-HRQL 评分较低（24.3 分 vs 30.0 分，p=0.031）。进行了短期（5 周[IQR 4，8]）、中期（14 个月[IQR 7.25，31]）和长期（6.75 年[IQR 5.5，8]）随访。在短期（6.0 分 vs 7.1 分，p=0.630）、中期（12.0 分 vs 12.1 分，p=0.818）和长期（10.0 分 vs 9.0 分，p=0.757）随访时，边缘性和 GERD 患者的 GERD-HRQL 评分无差异。GERD-HRQL 的长期绝对改善为-12.3（p=0.022）vs.-21.3（p<0.001）。在长期随访中，PPI 使用（50% vs 47%，p=0.852）、满意度（58% vs 76%，p=0.187）、基于事后认识的重复手术意愿（75% vs 85%，p=0.386）或再次手术的需求（14% vs 13%，p=0.910）无差异。
腹腔镜 Nissen 胃底折叠术后 7 年，边缘性 GERD 和 GERD 患者的 GERD-HRQL 均得到改善，且长期 PPI 使用和对手术结果的满意度相似。基线时边缘性 GERD 患者的 GERD-HRQL 较低，因此其生活质量评分改善较小。对于药物治疗无效的边缘性 GERD 患者，应考虑抗反流手术。
