Domergue J, Fabre J M
Presse Med. 1995 Jan 28;24(4):205-8.
Widespread us of laparoscopic surgery adds a new element to the debate over the choice between medical or surgical treatment for gastro-oesophageal reflux. Patients and gastroenterologists often favour medical management to avoid post-operative pain, a long recovery period, an abdominal scar or the risk of eventration but at the cost of long-term drug therapy and the need for repeated check-ups and endoscopy examinations. Yet surgery was found to give better long-term results in the only study comparing surgery and medical treatment. The question of cost and insurance coverage must also be considered. Although the indications for laparoscopic surgery would be identical to those for laparotomy it is probably possible that a wider population could benefit from this technique as laparoscopic cure can be indicated as an alternative in patients highly dependent on drug therapy. Relapse in patients with a long-term medical regimen is another recent indication. We should however always keep in mind that good outcome after laparoscopic surgery depends not only on a correct indication and evaluation of the oesophageal motricity but also on the skill and experience of the surgical team. Laparoscopic cure should certainly play a major role in the treatment of gastro-oesophageal reflux and will undoubtedly soon be the second most frequent laparoscopic technique performed after laparoscopic cholecystectomy.
腹腔镜手术的广泛应用为胃食管反流病的药物治疗与手术治疗选择之争增添了新的因素。患者和胃肠病学家通常倾向于药物治疗，以避免术后疼痛、漫长的恢复期、腹部疤痕或发生腹疝的风险，但代价是长期药物治疗以及需要反复进行检查和内镜检查。然而，在唯一一项比较手术和药物治疗的研究中，发现手术能带来更好的长期效果。成本和保险覆盖范围的问题也必须加以考虑。尽管腹腔镜手术的适应证与剖腹手术相同，但可能有更广泛的人群能从这项技术中受益，因为对于高度依赖药物治疗的患者，腹腔镜治疗可被视为一种替代方案。长期药物治疗患者的复发是近期的另一个适应证。然而，我们应始终牢记，腹腔镜手术后的良好效果不仅取决于正确的适应证和对食管动力的评估，还取决于手术团队的技术和经验。腹腔镜治疗在胃食管反流病的治疗中肯定应发挥主要作用，并且无疑很快将成为仅次于腹腔镜胆囊切除术后第二常见的腹腔镜技术。
