Kamat Ritesh, Patankar Roy, Supe Avinash, Dubey Pallavi, Thapar Ravi, Kalikar Vishakha
Department of Radiology, Delta Imaging, Zen Multispeciality Hospital, Mumbai, Maharashtra, India.
J Minim Access Surg. 2025 Apr 1;21(2):153-161. doi: 10.4103/jmas.jmas_325_23. Epub 2024 Nov 29.
With increasing numbers and acceptability of laparoscopic anti-reflux surgery (LARS) procedures over long-term medical treatment in the past decade, it follows that the complications of fundoplication wrap are seen intermittently with recurrent symptoms of heartburn and dysphagia. Endoscopy and barium swallow are the initial investigations performed for suspected fundoplication wrap failures. However, with easy availability of multislice computed tomography (CT) and the multiplanar reconstructions along with reduction in familiarity with barium examinations, it would be prudent for the surgeons to familiarise themselves with various appearances of wrap failure. Currently, there is no accepted standard to report a fundoplication wrap failure. We did a thorough literature review on the use of CT scans for fundoplication wrap failure, created a multidisciplinary hernia team with prominent radiologists and surgeons and discussed the role of CT scans in the management of suspected wrap failure. After completing a pilot study with around 43 patients of wrap failure, we created a standard CT reporting format which helped us in the management of even the most complex cases. This standard reporting format can be used by trainees and surgeons worldwide. This would lead to uniformity in reporting, would help in decision-making and would also help create national and international primary wrap failure and redo fundoplication registry.
A total of 43 patients of wrap failure of multislice CT evaluation were analysed for type of failure along with factors responsible for the maintenance of integrity of the wrap. A novel checklist with structured reporting was used for the description of the post-operative imaging findings.
The demographic characteristics, post-operative imaging and intraoperative findings were described. The different types of wrap failure - Hinder types and associated pathologies were analysed for relative frequency in wrap failures. The novel structured reporting included wrap integrity and failure complications in post-operative patients of LARS.
Fundoplication wrap failure is not an uncommon complication seen after LARS. A novel structured report with checklist will help the surgeons to evaluate the post-operative patient with recurrent symptoms. Multislice CT is the ideal modality for imaging suspected wrap failures after primary endoscopic evaluation. Multiplanar imaging with coronal and sagittal reconstructions is useful for understanding the integrity of the wrap and its ability to detect failure/migration.
在过去十年中，腹腔镜抗反流手术（LARS）的数量不断增加且比长期药物治疗更易被接受，随之而来的是胃底折叠术包绕处的并发症会间歇性出现烧心和吞咽困难的复发症状。内镜检查和吞钡检查是针对疑似胃底折叠术包绕失败进行的初始检查。然而，随着多层螺旋计算机断层扫描（CT）的广泛应用以及多平面重建技术的发展，同时人们对钡剂检查的熟悉程度降低，外科医生熟悉包绕失败的各种表现是明智的。目前，尚无公认的报告胃底折叠术包绕失败的标准。我们对CT扫描在胃底折叠术包绕失败中的应用进行了全面的文献综述，组建了一个由杰出放射科医生和外科医生组成的多学科疝病团队，并讨论了CT扫描在疑似包绕失败管理中的作用。在对约43例包绕失败患者进行初步研究后，我们创建了一种标准的CT报告格式，这有助于我们处理即使是最复杂的病例。这种标准报告格式可供全球的实习医生和外科医生使用。这将导致报告的一致性，有助于决策，也有助于创建国家和国际原发性包绕失败及再次胃底折叠术登记系统。
对43例多层螺旋CT评估显示包绕失败的患者进行了失败类型以及维持包绕完整性相关因素的分析。使用一种带有结构化报告的新颖检查表来描述术后影像学检查结果。
描述了患者的人口统计学特征、术后影像学检查结果和术中发现。分析了不同类型的包绕失败——阻碍类型及相关病理情况在包绕失败中的相对频率。这种新颖的结构化报告包括LARS术后患者的包绕完整性和失败并发症。
胃底折叠术包绕失败是LARS术后并不罕见的并发症。一种带有检查表的新颖结构化报告将有助于外科医生评估有复发症状的术后患者。多层螺旋CT是在初步内镜评估后对疑似包绕失败进行成像的理想方式。冠状面和矢状面重建的多平面成像有助于了解包绕的完整性及其检测失败/移位的能力。
