Ciriza de Los Ríos Constanza, Gil Remezal Laura, Molano Nogueira Francisco Javier, García Pravia Laura, Sánchez Pernaute Andrés, Rey Enrique
Gastroenterology, Hospital Clínico San Carlos. Universidad Complutense de Madrid, Spain.
Gastroenterology, Hospital Clínico San Carlos. Universidad Complutense de Madrid, España.
Rev Esp Enferm Dig. 2025 Jun;117(6):319-326. doi: 10.17235/reed.2025.10615/2024.
laparoscopic Nissen fundoplication (LNF) is the gold standard of antireflux surgery. Up to 30 % of patients experience symptoms after surgery, with insufficient information available. The main objective was to evaluate epidemiological, clinical, and functional factors associated with symptoms after LNF.
a retrospective case-control study was performed of 79 operated patients (2015-2024). The relationship between epidemiological data, functional tests, and imaging study results with the occurrence of symptoms after LNF was assessed.
twenty-four asymptomatic and 55 symptomatic patients were included. Functional and imaging tests were normal in the majority of asymptomatic patients. integrated relaxation pressure over 4 seconds (IRP-4s) (95th percentile) in asymptomatic patients was 20.4 mmHg. Female gender (OR 4, 95 % CI: 1.1-14), preoperative dysphagia (OR 8.2, 95 % CI: 1.4-47.6), and IRP-4s (OR 1.2, 95 % CI: 1-1.3) were independent factors for postoperative dysphagia. Type III esophagogastric junction morphology on high-resolution manometry (OR 6.1, 95 % CI: 2.1-18.1) was independently associated with gastroesophageal reflux disease (GERD) symptoms. Acid exposure time (AET) showed a trend toward being an independent factor but did not reach statistical significance (OR 1.1, 95 % CI: 1-1.3). Hiatal hernia in the esophagogram was associated with reintervention (OR 5.5, 95 % CI: 1.6-19.1).
asymptomatic patients mostly have normal functional tests after LNF, although IRP-4s normal value (95th percentile) is higher than proposed in the Chicago classification. Preoperative dysphagia and female gender are independent factors for postoperative dysphagia, which should be considered in the preoperative assessment. Functional and imaging tests are essential in evaluating patients with postoperative symptoms. Dysphagia is associated with higher IRP while GERD symptoms are related to type III esophagogastric junction (EGJ) on high resolution manometry (HRM). Similarly, a hiatal hernia on the esophagogram is associated with reintervention.
腹腔镜尼氏胃底折叠术（LNF）是抗反流手术的金标准。高达30%的患者术后出现症状，且相关信息不足。主要目的是评估与LNF术后症状相关的流行病学、临床和功能因素。
对79例接受手术的患者（2015 - 2024年）进行回顾性病例对照研究。评估了流行病学数据、功能测试和影像学研究结果与LNF术后症状发生之间的关系。
纳入24例无症状患者和55例有症状患者。大多数无症状患者的功能和影像学检查正常。无症状患者4秒以上综合松弛压（IRP - 4s）（第95百分位数）为20.4 mmHg。女性（比值比4，95%置信区间：1.1 - 14）、术前吞咽困难（比值比8.2，95%置信区间：1.4 - 47.6）和IRP - 4s（比值比1.2，95%置信区间：1 - 1.3）是术后吞咽困难的独立因素。高分辨率测压显示的III型食管胃交界形态（比值比6.1，95%置信区间：2.1 - 18.1）与胃食管反流病（GERD）症状独立相关。酸暴露时间（AET）显示出成为独立因素的趋势，但未达到统计学意义（比值比1.1，95%置信区间：1 - 1.3）。食管造影显示的食管裂孔疝与再次干预相关（比值比5.5，95%置信区间：1.6 - 19.1）。
LNF术后无症状患者大多功能测试正常，尽管IRP - 4s正常值（第95百分位数）高于芝加哥分类法中提出的数值。术前吞咽困难和女性是术后吞咽困难的独立因素，术前评估时应予以考虑。功能和影像学检查对于评估术后有症状的患者至关重要。吞咽困难与较高的IRP相关，而GERD症状与高分辨率测压（HRM）显示的III型食管胃交界（EGJ）相关。同样，食管造影显示的食管裂孔疝与再次干预相关。
