Single-Site Nissen Fundoplication Versus Laparoscopic Nissen Fundoplication

Background:

Advances in minimally invasive surgery have led to the emergence of single-incision laparoscopic surgery (SILS). The purpose of this study is to assess the feasibility of SILS Nissen fundoplication and compare its outcomes with traditional laparoscopic Nissen fundoplication.

Methods:

This is a retrospective study of 33 patients who underwent Nissen fundoplication between January 2009 and September 2010.

Results:

There were 15 SILS and 18 traditional laparoscopic Nissen fundoplication procedures performed. The mean operative time was 129 and 182 minutes in the traditional laparoscopic and single-incision groups, respectively (P = .019). There were no conversions in the traditional laparoscopic group, whereas 6 of the 15 patients in the SILS group required conversion by insertion of 2 to 4 additional ports (P = .0004). At short-term follow-up, recurrence rates were similar between both groups. To date, there have been no reoperations.

Conclusions:

SILS Nissen fundoplication is both safe and feasible. Short-term outcomes are comparable with standard laparoscopic Nissen fundoplication. Challenges related to the single-incision Nissen fundoplication include overcoming the lengthy learning curve and decreasing the need for additional trocars.     

Pathophysiological Measurement and Results After Laparoscopic Fundoplication for Gastroesophageal Reflux Disease

Purpose: Both surgical and conservative treatments for gastroesophageal reflux disorder (GERD) are controversial. The aim of this prosepective study was to examine outcomes after laparoscopic antireflux surgery. Methods: The subjects were 143 patients who underwent laparoscopic antireflux surgery. Following diagnostic procedures 126 patients were allocated to a total fundoplication group (360°C, Nissen-DeMeester) and 17, to a posterior semifundoplication group (250–270°, Toupet). All complications were registered, and pathophysiological and outcome data were examined 3, 6, and 9 months after surgery. Results: By 6 months after surgery the mean lower esophageal sphincter (LES) pressure had improved significantly, to 14.8 mmHg in the Nissen-DeMeester group, and to 12.1 mmHg in the Toupet group, corresponding to successful prevention of esophageal reflux in both groups. Dysphagia was more common in the early postoperative period after total fundic wrap (17% vs 12%), but this difference disappeared in time. All patients reported complete relief of reflux symptoms, although two of those who underwent the Nissen-DeMeester fundoplication experienced relapse of GERD and required open reconstruction (1.4%). The laparoscopic procedure was converted to open surgery in three patients (2%). There were no associated deaths and the perioperative complication rate was 4.2%. Conclusion: Laparoscopic antireflux surgery is an effective treatment for GERD. More than 93% of the patients in this series rated their outcome as good to excellent following the operation. Received: December 10, 2001 / Accepted: May 7, 2002 Reprint requests to: K. Ludwig     

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目的探讨伴随的精神症状是否会影响腹腔镜胃底折叠术的效果,手术是否能够改善伴随的精神症状。方法回顾性分析2001年6月至2004年7月收治的51例腹腔镜胃底折叠术后胃食管反流性疾病的临床资料。结果无精神症状组症状评分由9.50±3.07降到1.87±1.64(P=0.000),生活质量评分(G IQLI)由122.63±3.16提高到139.25±1.98(P=0.000);有精神症状组症状评分由11.63±3.46降到9.25±2.12(P=0.023),G IQLI评分由103.63±5.29提高到107.75±5.18(P=0.016),均不如无精神症状组改善显著,而且G IQLI评分中反映精神因素的评分改善无显著性(P=0.104)。无精神症状组93%对手术效果满意,而有精神症状组仅为25%。无精神症状组与有精神症状组食道下段压力和24h pH值监测评分的改善程度与手术前比差异均有显著性,并达到正常范围。无手术并发症,无中转开腹及死亡病例。结论伴随的精神症状影响手术对主观症状的改善,但不影响客观指标的改善;手术可改善疾病相关症状,但对精神症状无明显改善。对伴有非常严重的精神症状的病人,手术应持谨慎态度。     

腹腔镜Nissen胃底折叠术治疗胃食管反流病110例报告

目的探讨胃食管反流病（gastroesophageal reflux disease,GERD）的临床表现、腹腔镜Nissen胃底折叠术的治疗效果。方法回顾性分析2007年1月～2008年12月共110例行腹腔镜Nissen胃底折叠术的GERD临床资料。18例以反酸、烧心、嗳气、反食、胸痛等食管内症状为主,92例表现为咳嗽、咳痰、喘息等呼吸道症状为主（6例无反酸、烧心等消化道症状）。结果中转开腹1例,余均成功实施腹腔镜Nissen胃底折叠术。手术时间30～245min,平均67.8min;术中出血量5～450ml,平均28.8ml;术后住院时间2～8d,平均4.1d。术后102例获得6～24个月随访,平均13个月,8例失访。其中66例仅接受电话随访。102例按照症状频次、程度问卷表对其症状进行评分,参考反流性疾病问卷（reflux diagnostic questionnaire,RDQ）评分标准症状评分,术后6个月反酸、烧心、胸痛、咳嗽、喘息、憋气、咽异物感、喉部发紧、声音嘶哑的评分均明显下降（P〈0.05）。87例手术有效,15例手术无效。术后62例（60.8%）出现进食困难,经饮食训练2～6周后60例消失,2例症状严重,经胃镜扩张后缓解。1例术后2个月食管裂孔疝复发,再次腹腔镜手术修补。36例术后3个月选择性地进行了胃镜、24h食管pH监测和食管压力监测复查。28例食管炎患者复查胃镜,25例恢复正常,1例从Ⅲ级转为Ⅰ级,1例从Ⅱ级转为Ⅰ级,1例无变化;31例复查24h食管pH值监测,DeMeester评分恢复正常30例,1例从中度降至轻度;18例复查食管测压,下食管括约肌（LES）静息压从术前的1.2～34.1（中位数14.3）mmHg升至14.3～33.0（中位数20.0）mmHg（Z=3.72,P=0.000）。结论腹腔镜Nissen胃底折叠术是治疗GERD的有效方法,具有微创、损伤小、病人恢复快和操作安全的优点,对诊断明确的以食管外症状为主要表现的GERD特别值得提倡。     

Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease in Japan

Purpose Laparoscopic antireflux surgery is the standard treatment for gastroesophageal reflux disease (GERD) in Western countries where this disorder is common; however, it has only recently been introduced in Japan. We examined the effectiveness of laparoscopic antireflux surgery in a small series of Japanese patients.Methods Between 1998 and 2001 we performed laparoscopic Nissen fundoplication in 23 patients to evaluate the efficiency of this technique. We examined the following four parameters pre- and postoperatively: symptoms, endoscopic findings, gastroesophagogram findings, and the results of intraesophageal 24-h pH monitoring. We also examined the operation time, blood loss, intraoperative complications, and postoperative complications.Results The operation was safely performed in all patients, regardless of age, and there were no intraoperative complications. Postoperatively, more than three parameters were effectively normalized in 17 (89.5%) of 19 patients. The only postoperative complications were delayed gastric emptying in three patients and persistent dysphagia in five patients. During follow-up, esophagitis recurred in two patients, one of whom underwent laparoscopic refundoplication, which normalized the condition.Conclusion Laparoscopic Nissen fundoplication is highly effective for GERD and could become the standard surgical treatment in Japan.     

Laparoscopic sleeve gastrectomy with Rossetti fundoplication: long-term (5-year) follow-up

BackgroundGastroesophageal reflux disease (GERD), including erosive esophagitis, is highly prevalent in the obese population. Barrett’s esophagus is the consequence of untreated GERD. Laparoscopic sleeve gastrectomy is one of the most frequently performed bariatric procedures. This study presents results after 5 years of follow-up of combined LSG and Rossetti fundoplication for the treatment of GERD, esophagitis, and Barrett’s esophagus in patients with morbid obesity.ObjectiveTo evaluate long-term results after sleeve gastrectomy with Rossetti fundoplication.SettingPublic university hospital in Italy.MethodsSince January 2015, more than 450 patients with obesity underwent sleeve gastrectomy with a Rossetti fundoplication procedure as part of prospective studies underway at our center performed by 4 different expert bariatric surgeons. Currently, 127 patients have a follow-up of 5 years or more.ResultsMean patient age was 42.9 ± 10.3 years, and mean body mass index was 42.4 ± 6.1 kg/m². In total, 74.8% of patients were experiencing GERD before surgery. In 29 of 127 patients (22.8%), preoperative gastroscopy showed signs of esophagitis and/or Barrett’s esophagus. In particular, 23 of 127 patients (18.1%) had grade A esophagitis, 2 of 127 (1.6%) had grade B, 2 of 127 (1.6%) had grade C, and 2 of 127 (1.6%) had Barrett’s esophagus. Mean operative time was 51 ± 21 minutes. No intraoperative complications or conversions were reported. A regular postoperative course was seen in 91.3% of patients. Sixty months after surgery, more than 95% of patients did not experience any reflux symptoms. Percent total weight loss at follow-up was comparable with that with sleeve gastrectomy. Endoscopic follow-up demonstrated improvement of esophagitis lesions (including Barrett’s esophagus) present in the preoperative setting.ConclusionLaparoscopic sleeve gastrectomy with Rossetti fundoplication is well tolerated, feasible, and safe in patients with obesity, providing adequate weight loss results and complete resolution of clinical signs of GERD. We have recorded an improvement in esophagitis lesions present at preoperative gastroscopy and complete resolution of Barrett’s esophagus within 5 years of follow-up.     

Gastrectomy as a Remedial Operation for Failed Fundoplication

The decision for, and choice of, a remedial antireflux procedure after a failed fundoplication is a challenging clinical problem. Success depends upon many factors including the primary symptom responsible for failure, the severity of underlying anatomic and physiologic defects, and the number and type of previous remedial attempts. Satisfactory outcomes after reoperative fundoplication have been reported to be as low as 50%. Consequently, the ideal treatment option is not clear. The purpose of this study was to evaluate the outcome of gastrectomy as a remedial antireflux procedure for patients with a failed fundoplication. The study population consisted of 37 patients who underwent either gastrectomy (n = 12) with Roux-en-Y reconstruction or refundoplication (n = 25) between 1997–2005. Average age, M/F ratio, and preoperative BMI were not significantly different between the two groups. Outcome measures included perioperative morbidity, relief of primary and secondary symptoms, and the patients’ overall assessment of outcome. Mean follow up was 3.5 and 3.3 years in the gastrectomy and refundoplication groups, respectively (p = 0.43). Gastrectomy patients had a higher prevalence of endoscopic complications of GERD (58% vs 4%, p = 0.006) and of multiple prior fundoplications than those having refundoplication (75% vs 24%, p = 0.004). Mean symptom severity scores were improved significantly by both gastrectomy and refundoplication, but were not significantly different from each other. Complete relief of the primary symptom was significantly greater after gastrectomy (89% vs 50%, p = 0.044). Overall patient satisfaction was similar in both groups (p = 0.22). In-hospital morbidity was higher after gastrectomy than after refundoplication (67% vs 20%, p = 0.007) and new onset dumping developed in two gastrectomy patients. In select patients with severe gastroesophageal reflux disease (GERD) and multiple previous fundoplications, primary symptom resolution occurs significantly more often after gastrectomy than after repeat fundoplication. Gastrectomy, however, is associated with higher morbidity. Gastrectomy is an acceptable treatment option for recurrent symptoms particularly when another attempt at fundoplication is ill advised, such as in the setting of multiple prior fundoplications or failed Collis gastroplasty. Presented at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, Los Angeles, California, May 20–24, 2006.     

Preoperative Lower Esophageal Sphincter Manometry Data Neither Impact Manifestations of GERD nor Outcome After Laparoscopic Nissen Fundoplication

Background  Experience with laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) and manometrically intact lower esophageal sphincter (LES) is limited. The disease pattern may be different and LARS may fail to control reflux or result in higher rates of dysphagia. This is the first study investigating the impact of preoperative LES manometry data not only on manifestations of GERD and subjective outcome alone but also on objective outcomes 1 year after LARS. Methods  Three hundred fifty-one GERD patients underwent LARS and had subjective symptom and quality of life assessment, upper gastrointestinal endoscopy, barium swallow esophagogram, 24-h esophageal pH monitoring, and manometry pre- and 1 year postoperatively. Patients were divided into those with a preoperatively intact versus defective LES based on intraabdominal length and resting pressure. Baseline and 1-year postoperative follow-up data were compared. Results  Preoperative manifestations of GERD were similar in each group. Postoperatively, all symptoms except flatulence, quality of life scores, and objective manifestations improved significantly in each group. Conclusions  The preoperative manometric character of the LES neither impacts the manifestations of GERD nor subjective and objective outcomes after LARS. Patients with GERD and manometrically intact LES have no higher risk for postoperative dysphagia.     

腹腔镜胃底折叠术治疗胃食管反流病

目的探讨腹腔镜胃底折叠术治疗胃食管反流病的临床效果。方法2008年1月-2011年11月对40例胃食管反流病行腹腔镜胃底折叠术。腹腔镜单纯胃底折叠术7例（Toupt式）,腹腔镜食管裂孔疝修补加胃底折叠术33例（Nissen式5例,Toupet式28例）。结果手术均获成功,无中转开腹及死亡病例,无术后严重并发症。手术时间75～215min,平均112min;术中出血量10-350ml,平均52ml;术后住院5—10d,平均7d。40例术后随访1—24个月,平均16个月,34例临床症状完全消失,6例症状明显好转。结论腹腔镜胃底折叠术治疗胃食管反流病疗效满意。     

Effect of Laparoscopic Fundoplication on Hypertensive Lower Esophageal Sphincter Associated with Gastroesophageal Reflux

For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently, the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically proven hypertensive lower esophageal sphincter was performed. Laparoscopic floppy Nissen fundoplication was performed in all cases. The first follow up was performed 6 weeks after the operation. The mean follow up time was 56 months (range 50–61). Before the operation, all patients had abnormal esophageal acid exposure. Mean DeMeester score was 41.7 (range 16.7–86). Average LES pressure before the operation was 50.5 mmHg (range 35.6–81.3). Six weeks after operation, all patients were symptom free. DeMeester score returned to a normal level of 2.9. Furthermore, a marked decrease in the lower esophageal sphincter pressure (24.7 mmHg) was detected. At late follow up, all patients were symptom-free, and only two patients agreed to undergo functional testing. The mean DeMeester score of this two patients was 1.2. The pressure remained at normal value (15.7 mmHg). In our study, an antireflux operation normalized lower esophageal sphincter pressure suggesting that abnormal esophageal acid exposure may be an etiologic factor in the development of hypertensive lower esophageal sphincter.     

Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease

Background It is known that laparoscopic antireflux surgery (LARS) can achieve an excellent surgical outcome including quality of life improvement in patients with erosive gastroesophageal reflux disease (GERD; EGD-positive). Less is known about the long-term surgical outcome in GERD patients who have no evidence of esophagitis (EGD-negative) before surgery. The aim of this study was to evaluate the surgical outcome in a well-selected group of EGD-negative patients compared to that of EGD-positive patients.Methods From a large sample of more than 500 patients who underwent LARS, 89 EGD-negative patients (mean age, 51 ± 6 years; 56 males) were treated surgically because of persistent reflux-related symptoms despite medical therapy. In all cases, preoperative 24-h pH monitoring showed pathological values. To perform a comparative analysis, a matched sample of EGD-positive patients (mean age, 54 ± 10 years; 58 males) was selected from the database. Surgical outcome included for all patients objective data (e.g., manometry and pH data and endoscopy), quality of life evaluation [Gastrointestinal Quality of Life Index (GIQLI)] symptom evaluation, as well as patients’ satisfaction with surgery. The data of a complete 5-year follow-up are available.Results There were no significant differences in symptomatic improvement, percentage of persistent surgical side-effects, or objective parameters. In general, patients’ satisfaction with surgery was comparable in both groups: 95% rated long-term outcome as excellent or good and would undergo surgical treatment again if necessary, respectively. Quality of life improvement was significantly better (p < 0.05) in the EGD-negative group because of the fact that GIQLI was more impaired before surgery (preoperative GIQLI, 81.7 ± 11.6 points/EGD-negative vs 93.8 ± 10.3 points/EGD-positive). Five years after surgery, GIQLI in both groups (121.2 ± 8.5 for EGD-negative vs 120.9 ± 7.3 for EGD-positive) showed comparable values to healthy controls (122.6 ± 8.5).Conclusion We suggest that LARS is an excellent treatment option for well-selected patients with persistent GERD-related symptoms who have no endoscopic evidence of esophagitis.Poster presented at the 11th International Congress of the European Association for Endoscopic Surgery, Glasgow, 2003     

Laparoscopic versus open Nissen fundoplication in infants after neonatal laparotomy.

BACKGROUND: Nissen fundoplication is an effective treatment of gastroesophageal reflux in infants. Laparoscopic procedures after previous laparotomy are technically more challenging. The role of laparoscopic Nissen fundoplication after neonatal laparotomy for diseases unrelated to reflux is poorly described. METHODS: This was a retrospective review of open vs laparoscopic Nissen fundoplication in infants after neonatal laparotomy. Of 32 infants who underwent neonatal laparotomy, 26 required a surgical antireflux operation within the first year of life. Twelve infants underwent laparoscopic Nissen fundoplication versus 14 infants who underwent open Nissen fundoplication. Parameters like age, weight, operative time, number of previous operations, length of stay following fundoplication, time to feedings, and complications were compared between the 2 groups. RESULTS: No statistically significant differences existed between most of the parameters compared following laparoscopic vs open Nissen fundoplication. No conversions to open procedures were necessary in infants undergoing laparoscopic fundoplication, and these infants resumed enteral feeds earlier than those who underwent the open procedure. CONCLUSION: Laparoscopic compared with open Nissen fundoplication performed in infants after a neonatal laparotomy were comparable procedures across most data points studied. However, a laparoscopic fundoplication did allow for earlier return to enteral feeds compared with the open approach. Laparoscopic Nissen fundoplication is technically feasible, safe, and effective in the treatment of gastroesophageal reflux in infants with a previous neonatal laparotomy.     

儿童腹腔镜下胃底折叠术10年小结

目的探讨腹腔镜下不同胃底折叠术治疗儿童胃食管反流性疾病的疗效。方法回顾性分析2000年10月～2011年2月10年中2个儿童医疗中心收治儿童胃食管反流性疾病81例(上海儿童医学中心30例,新华医院51例)临床资料,包括食管裂孔疝76例,单纯严重胃食管反流5例。男49例,女32例。年龄25天～11岁。2例有食管裂孔疝修补手术史。采用5个5 mm trocar分别经脐和两上腹、两侧中腹部进腹,保留脾胃韧带完成食管裂孔疝修补和胃底折叠术。结果79例镜下完成手术(包括Nissen-Rossetti术37例,Thal术42例),2例中转开放手术。出院前均行食管钡餐(GI)复查,37例Nissen-Rossetti术后9例轻～中度食管下端狭窄,1～2次扩张后缓解症状;42例Thal术后7例存在轻度反流。术后69例获随访,时间2个月～7年,平均26个月。2例食管裂孔疝术后1个月复发,再次镜下手术,1例证实膈肌脚尼龙缝合线松脱,1例裂孔关闭不够,仍有一较小旁疝形成,均再次镜下修补,术后恢复好;1例术后出现发作性腹痛伴呕吐;1例智力发育障碍者术后吞咽功能退化,顽固性拒食,长期鼻胃管喂养;2例胃食管轻～中度反流伴有胃动力差。其余63例术后生长发育好,术前临床症状消失。结论①腹腔镜下胃底折叠术治疗各种原因导致的儿童胃食管反流是一种安全有效的手术途径。②对于食管裂孔疝,选择镜下Thal术可有效减少术后食管狭窄的发生。③对于严重胃食管反流,选择Nissen-Rossetti术,术后抗反流效果更确切,与传统的Nissen术相比,保留胃短血管的Nissen-Rossetti术操作更简便。     

Laparoscopic Fundoplication in Patients with a Hypertensive Lower Esophageal Sphincter

Background  A small proportion of patients evaluated with manometry prior to a fundoplication have a high-pressure lower esophageal sphincter (LES). This paper examines the outcome of laparoscopic fundoplication for these patients. Material and Methods  Between October 1991 and December 2006, 1,886 patients underwent primary laparoscopic fundoplication. Those with a high-pressure LES on preoperative manometry (LESP ≥30 mm Hg at end expiration) were identified from a prospective database. Long-term outcomes were determined using analogue symptom scores (0–10) for heartburn, dysphagia, and patient satisfaction and compared to those of a matched control group. Results  Thirty patients (1.6%), nine men and 21 women, median age 51 years, had a hypertensive LES (mean, 36 mmHg; range, 30–55). Median follow-up after fundoplication was 99 (12–182) months. These patients had similar mean symptom scores to 30 matched controls for heartburn (2.3 vs. 2.2, P = 0.541), dysphagia (2.7 vs. 3.1, P = 0.539), and satisfaction (7.4 vs. 7.6, P = 0.546). Five patients required revision for dysphagia compared to no control patients (P = 0.005). These patients had a higher preoperative dysphagia score (6.6 vs. 3.1, P = 0.036). Conclusion  Laparoscopic fundoplication can be performed with good long-term results for patients with reflux and a hypertensive LES. However, those with preoperative dysphagia have a higher failure rate.     

腹腔镜高选择性迷走神经切断术联合Nissen胃底折叠术:效果如何?——腹腔镜Nissen迷走神经切断术治疗胃食管返流

背景：Nissen胃底折叠术（Nissen fundoplication，NF）已不是治疗胃食管返流性疾病（gastroesophageal reflux disease，GERD）的唯一、有效的方法。对于能降低胃酸的手术方式来讲，如高选择性迷走神经切断术（highly selective vagotomy，HSV），也不仅仅是一种辅助治疗方法。对高选择性迷走神经切断术联合Nissen胃底折叠术（Nissen fundoplication with highly selective vagotomy，NFHSV）治疗GERD的作用目前尚无完整的评价。方法：2003年6月～2005年6月8例女性病人接受NFHSV，8例均有6个月GERD病史，经药物治疗症状无缓解，有餐前痛、消化性溃疡或严重的胃炎。平均随访时间12个月，术前、术后进行烧心严重程度评分测定（heart burn severity score，HSS）。结果：平均手术时间110min，无手术并发症。1例术后须用质子泵抑制剂，术后经戒烟5个月后停药。8例术后症状和烧心严重程度评分测定有明显改善。结论：NFHSV是有效的联合手术方式，尚需要进一步的研究证实这一联合术式的完全有效性和安全性。     

Laparoscopic mesh-augmented hiatoplasty as a method to treat gastroesophageal reflux without fundoplication: single-center experience with 306 consecutive patients

Background

Laparoscopic fundoplication represents the surgical standard treatment of gastroesophageal reflux disease. However, because of persisting side effects the method is not without controversy. Laparoscopic mesh-augmented hiatoplasty might be an alternative.

Methods

In 306 consecutive patients the perioperative course and symptomatic outcome was analyzed after a mean follow-up period of 52 months.

Results

The mean DeMeester symptom score decreased from 5.3 to 2.0 (P < .001). Acid-suppressive therapy on a regular basis was discontinued in 79% of patients. The gas bloating value decreased from .7 to .5 (P = .031), and the dysphagia value increased from .5 to .9 (P < .001). Belching and vomiting were possible in 93% and 88% of patients, respectively. Mesh-related complications with the need for reoperation occurred in 1% of patients.

Conclusions

Laparoscopic mesh-augmented hiatoplasty is safe and does have an antireflux effect even without fundoplication. Side effects seem to be reasonable.     

Laparoscopic Nissen fundoplication after failure of Enteryx injection into the lower esophageal sphincter

Background We investigated the feasibility, safety, and efficacy of laparoscopic antireflux surgery (LARS) after failure of Enteryx injection in the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD).Methods Four patients underwent LARS after failure of Enteryx injection. Particular care was taken during the procedure to identify unusual material or fibrosis.Results All patients underwent LARS successfully. In three patients, tight adhesions with fibrous tissues and black foreign material were observed around the esophagus. No complications occurred during the procedures. The postoperative period was uneventful and functional results were excellent.Conclusion LARS following Enteryx injection is feasible. Careful dissection is mandatory to avoid operative complications. Both techniques may be considered as options for treating GERD.     

超重患者胃食管反流病的腹腔镜治疗

目的 探讨腹腔镜手术治疗超重患者胃食管反流病（gastroesophageal reflux disease,GERD）的临床效果.方法 2008年1月~2013年1月,对23例体重指数（BMI）26.1~29.7的超重GERD患者行腹腔镜治疗.单纯胃底折叠术5例（Toupet式）,18例合并食管裂孔疝者行食管裂孔疝修补加胃底折叠术（Nissen式4例,Toupet式14例）.结果 全组手术均获成功,手术时间85~225 min,平均117 min;术中出血量30~200 ml,平均70 ml;术后住院时间4~8 d,平均7 d.无中转开腹及死亡,无术后严重并发症.术后随访1~24个月,平均14个月,其中15例〉12个月,21例治愈,2例缓解.结论 腹腔镜食管裂孔疝修补和胃底折叠术治疗超重GERD患者效果满意.     

Therapeutic Effects of Laparoscopic Fundoplication for Nonerosive Gastroesophageal Reflux Disease

Purpose Surgical treatments for nonerosive gastroesophageal reflux disease (NERD) have not been investigated sufficiently. We examined the results of laparoscopic fundoplication for patients with NERD. Methods We performed laparoscopic fundoplication for NERD in 22 patients. The severity of esophageal hiatal hernia, morphology of the cardiac orifice, and results of 24-hour continuous esophageal and gastric pH were evaluated. We used a four-point scale for the improvement rating of postoperative symptoms. Results There were 20 patients (91%) with a sliding hiatal hernia, and 21 patients (95%) with a loose cardiac orifice. Seven patients had acid reflux with 4.0% or higher esophageal fraction of time pH below 4. The surgical techniques used were Nissen fundoplication in 10 patients and Toupet fundoplication in 12 patients. Improvement of postoperative heartburn was rated as excellent in 16 patients, good in 5, and fair in 1. The overall efficacy rating was 95%, and discontinuation of proton pump inhibitor (PPI) was possible in 21 patients. Conclusion Our results of performing laparoscopic fundoplication in patients with NERD were excellent. Even if abnormal acid reflux cannot be confirmed preoperatively, sufficient therapeutic efficacy can be expected for patients with esophageal hiatal hernia or a loose cardiac orifice.