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比较大、小食管裂孔疝组时,refluxstop治疗胃酸反流的安全性和有效性评估:来自瑞士99例患者、长达4年随访的结果

A safety and effectiveness evaluation of refluxstop in the treatment of acid reflux comparing large and small hiatal hernia groups: results from 99 patients in Switzerland with up to 4-years follow-up.

作者信息

Borbély Yves, Kroell Dino, Gerber Sarah, Fringeli Yannick, Linas Ioannis, Zehetner Joerg

机构信息

Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.

Department of Visceral Surgery, Hirslanden Clinic Beau-Site, Bern, Switzerland.

出版信息

Hernia. 2025 May 3;29(1):156. doi: 10.1007/s10029-025-03339-2.

Abstract

BACKGROUND

Standard-of-care surgical treatments for gastroesophageal reflux disease (GERD), with large hiatal hernia (HH), result in a reoperation rate of up to 50% at 5 years. RefluxStop, acting as a mechanical stop without encircling the food passageway, offers a novel approach to treat large HH patients. This study assesses the safety and efficacy of RefluxStop surgery comparing large and small HH groups followed for up to 4 years.

METHODS

Two cohorts were retrospectively analyzed in a combined investigator-initiated study evaluating safety outcomes of RefluxStop in severe GERD subjects, comparing concomitant small (≤3 cm) and large HH (4-10 cm) in Switzerland. Primary outcomes were procedure-related adverse events (AEs/ADEs). The secondary outcome was improvement in GERD-HRQL score.

RESULTS

Ninety-nine subjects underwent the RefluxStop surgical procedure, whereof 50 subjects had small (≤3 cm) and 49 subjects had large HH (4-10 cm). One surgeon at each site operated on both small and large hernia patients. No significant difference in AEs between patients with small and large HH was shown. At 1-year follow-up, subjects in both groups experienced statistically significant improvements in median (IQR) GERD-HRQL score of 93.8% (81.8%; 98.7%) for those with large HH and 85.7% (76.5%; 92.3%) for those with small HH.

CONCLUSION

RefluxStop surgery for GERD effectively treats patients with large HH that currently have no optimal treatment options, while showing significantly improved results for up to 4 years. Furthermore, RefluxStop provides equally favorable results and a robust low risk profile for subjects with either concomitant small (n = 49) and large (n = 50) HH.

摘要

背景

对于伴有大型食管裂孔疝(HH)的胃食管反流病(GERD),标准的护理手术治疗在5年内的再次手术率高达50%。RefluxStop作为一种不环绕食物通道的机械性阻挡装置,为治疗大型HH患者提供了一种新方法。本研究评估了RefluxStop手术在长达4年的随访中,比较大型和小型HH组的安全性和有效性。

方法

在一项联合研究者发起的研究中,对两个队列进行回顾性分析,评估RefluxStop在严重GERD患者中的安全性结果,比较瑞士伴有小型(≤3厘米)和大型HH(4 - 10厘米)的情况。主要结局是与手术相关的不良事件(AE/ADE)。次要结局是GERD - HRQL评分的改善。

结果

99名受试者接受了RefluxStop手术,其中50名受试者患有小型(≤3厘米)HH,49名受试者患有大型HH(4 - 10厘米)。每个研究地点由一名外科医生对小型和大型疝患者进行手术。小型和大型HH患者之间的不良事件无显著差异。在1年随访时,两组受试者的GERD - HRQL评分中位数(IQR)均有统计学意义的改善,大型HH患者为93.8%(81.8%;98.7%),小型HH患者为85.7%(76.5%;92.3%)。

结论

RefluxStop手术治疗GERD能有效治疗目前没有最佳治疗选择的大型HH患者,并且在长达4年的时间里显示出显著改善的结果。此外,RefluxStop对于伴有小型(n = 49)和大型(n = 50)HH的受试者均提供了同样良好的结果和较低的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb79/12049369/6f04d577bdf8/10029_2025_3339_Fig1_HTML.jpg

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