腹腔镜Nissen胃底折叠术治疗胃食管返流病的长期效果

目的:评价腹腔镜Nissen胃底折叠术(laparoscopic Nissen fundoplication,LNF)治疗胃食管返流病的长期效果。方法:从MEDLINE、EMBASE、中国生物医学数据库(CBM)及Cochrane试验注册中心检索纳入了1991年到2007年10月发表的LNF治疗返流性食管炎的随机对照实验,并对纳入研究的方法学质量(随机方法、分配隐藏、盲法)进行评价,最后用Rev-Man4.2.9软件进行分析。结果:纳入4个随机对照实验(RCT),包括440例患者,纳入随访研究共387例。术后主观结果如满意度[OR0.5095%CI(0.25,1.00)]、术后抑酸药物的使用[OR0.4595%CI(0.08,2.53)]、返酸和烧心症状差异无统计学意义,吞咽困难LNF发生率高于传统胃底折叠术(conventional Nissen fundoplicationm,CNF)[OR4.1695%CI(1.51,11.50)]。客观结果如再手术率[OR1.7795%CI0.78,4.72)]、食管测压和24h pH检测两组间差异无统计学意义。结论:本研究中LNF治疗胃食管返流病的长期效果和传统胃底折叠术差异无统计学意义,但LNF术后吞咽困难发生率可能较高。     

Comparison of patient-centered outcomes after laparoscopic Nissen fundoplication for gastroesophageal reflux disease or paraesophageal hernia

Background Patients undergoing laparoscopic Nissen fundoplication (LNF) with paraesophageal hernias (PEH) are not only older and less healthy than those with gastroesophageal reflux disease (GERD), but in addition the repair is more complicated. We evaluated whether outcomes relating to GERD symptoms and quality of life (QOL) were impacted by the presence of PEH. Methods Prospectively entered data from 149 patients (109 GERD and 40 PEH) were evaluated prior to and one year after LNF with standardized and validated symptoms scores. Scores for heartburn, dysphagia, disease-specific QOL (GERD-HRQL), and general health-related QOL (SF-12 physical and mental component scores) were compared between patients undergoing LNF for PEH or for GERD alone, at baseline and one year after surgery. p < 0.05 was considered statistically significant. Results Preoperative data for GERD-HRQL, heartburn, and dysphagia were available for 134 patients, with 96% one-year follow-up. SF-12 data were collected for 98 patients with 100% follow-up. PEH patients were older and had greater comorbidity. Preoperative GERD-HRQL and heartburn were significantly worse in the GERD group. One year after surgery, both GERD and PEH patients showed significant improvement in GERD-HRQL, heartburn and dysphagia scores, with no difference in any of these disease or symptom measures between the two study groups. Postoperative PCS and MCS scores showed improvement in GERD patients, while PEH patient scores remained at or below the population mean. Conclusions LNF is equally effective as an antireflux procedure in both GERD and PEH patients, prevents symptoms of reflux in PEH patients that have none preoperatively, and does not increase dysphagia in either group. Despite the increased complexity of the procedure, LNF provides an effective control of reflux symptoms in patients undergoing PEH repair. Supported by an unrestricted educational grant from Tyco Healthcare Canada     

Laparoscopic Nissen fundoplication decreases gastroesophageal junction distensibility in patients with gastroesophageal reflux disease

Laparoscopic Nissen fundoplication (LNF) is the surgical treatment of choice for gastroesophageal reflux disease (GERD). Post-LNF complications, such as gas bloat syndrome, inability to belch and vomit, and dysphagia, remain too common and prevent LNF from being more highly recommended. It remains controversial as to whether preoperative assessment can predict the development of post-LNF complications. Some authors have shown a correlation between pre-LNF manometry characteristics and post-LNF dysphagia, and others have not. We hypothesize that many post-LNF complications are caused by a decrease in the distensibility of the GEJ and that standard manometry is at best an indirect measure of this. The aim of this study is to directly measure the effect of LNF on gastroesophageal junction (GEJ) distensibility (GEJD).The lower esophageal sphincter (LES) of 15 patients undergoing LNF was characterized using standard manometry. The GEJD before and after a standardized LNF was measured using a specialized catheter, containing an infinitely compliant bag, placed within the LES. GEJD was measured, as dV/dP over volumes 5 to 25 mL distended at a rate of 20 mL/min. Mean dP ± standard error of the mean for each volume was calculated, and distensibility curves were generated and compared. Measurements were also taken after abolishing LES tone by mid-esophageal balloon distension. Patient symptoms were recorded before and after surgery. Statistical analysis was performed by two-way repeated-measures analysis of variance, paired t test, and the Tukey test. Laparoscopic Nissen fundoplication led to a statistically significant increase in Dpressure over each volume tested and therefore a significant decrease in the distensibility of the GEJ. Abolition of LES tone had no statistical effect on GEJD after fundoplication. There were no complications, and none of the patients developed the symptom of dysphagia postoperatively. These are the first direct measurements to show that LNF significantly reduces the distensibility of the GEJ. We hypothesize that the magnitude of this reduction may be the vital variable in the development of post-LNF complications and specifically post-LNF dysphagia. The intraoperative measurement of LES distensibility may provide a means for avoiding this feared and other post-LNF complications in the future. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (poster presentation).     

Quality of life and symptomatic outcome three to five years after laparoscopic Toupet fundoplication in gastroesophageal reflux disease patients with impaired esophageal motility

BACKGROUND: Many centers practice a tailored approach to laparoscopic antireflux surgery in attempt to prevent postoperative side effects in gastroesophageal reflux disease (GERD) patients with an impaired esophageal motility. As a result of controversial findings reported in literature no worldwide accepted consensus exists regarding the appropriate indication for this tailored approach. The aim of this prospective study was to evaluate quality of life and symptomatic outcome in selected patients for a follow-up of 3 to 5 years. METHODS: A total of 155 patients with esophageal dismotility underwent laparoscopic Toupet fundoplication (LTF). Basic requirements for surgery included in all patients a detailed evaluation of symptoms and quality of life (Gastrointestinal Quality of Life Index [GIQLI]), esophagogastroduodenoscopy, 24-hour pH monitoring, and esophageal manometry. Patients were evaluated 6 weeks, 3 months, 1 year, and 3 to 5 years after LTF. RESULTS: GERD-related symptoms such as heartburn, regurgitation, dysphagia, or chest pain showed a significant improvement (P <0.05 to 0.001) in all gradings immediately after surgery. During the complete follow-up, a total of 4 patients (2.6%) required laparoscopic redo surgery because of recurrent GERD symptoms. Two patients (1.3%) were adequately maintained on short-term proton pump inhibitor therapy because of mild symptoms. All these patients have shown a pathological DeMeester score within the early period after surgery (3 months or 1 year control). Severe and persistent side effects have been present in 7 patients (4.5%), mild to moderate side effects in 11 patients (7.1%). Other side effects have been temporary and resolved spontaneously. GIQLI improved significantly (P <0.05 to 0.01) in all dimensions and persisted for at least 5 years with mean values comparable with healthy individuals. CONCLUSIONS: LTF is effective, well tolerated, and improves quality of life, improving long-term outcome with an acceptable rate of long-term side effects in GERD patients with moderate to severe esophageal dismotility for a follow-up period of 3 to 5 years.     

Gastroesophageal reflux,quality of life,and satisfaction in patients with achalasia treated with open cardiomyotomy and partial fundoplication

BACKGROUND: Cardiomyotomy, often associated with an antireflux technique, is effective in the management of achalasia, although gastroesophageal reflux (GER) may occur after the procedure. Patient-centered measures, ie, health-related quality of life (HRQoL) and satisfaction, should be included in the evaluation of the patients. METHODS: A study was made of the incidence of GER (symptoms, upper endoscopy and 24-hour pH monitoring), HRQoL (Short Form-36 Health Survey), and satisfaction after open-access cardiomyotomy and 180-degree anterior fundoplication in 28 consecutive patients, with a minimum postoperative follow-up of 12 months. RESULTS: Mean age was 45 years (range 15 to 80) and 68% were female. In 8 subjects (all with heartburn) GER morbidity was present (4 with esophagitis and 4 with positive pH study), and 6 patients required proton pump inhibitors. Short Form-36 scores after surgery were similar to those found in the general population. Patient satisfaction was high and was more related to the absence of dysphagia than to the presence of GER symptoms. CONCLUSIONS: Gastroesophageal reflux is relatively frequent after cardiomyotomy and partial fundoplication, although the efficacy of proton pump inhibitor treatment minimizes its clinical significance.     

Quality of life before and after laparoscopic Nissen fundoplication

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common disorder in the Western world. The acute disease can usually be managed by medical therapy. To prevent relapse, many patients require lifelong medication. In these patients, laparoscopic antireflux surgery offers a good alternative. The aim of this study was to evaluate the postoperative results and compare pre- and postoperative quality of life after laparoscopic Nissen fundoplication. METHODS: Clinical investigations, including esophageal manometry, pH monitoring, and endoscopy, and a previously validated Quality of Life Index, were performed before and a median of 41 month after antireflux surgery in 75 patients. RESULTS: After laparoscopic Nissen fundoplication, the percentage of total time with pH <4 decreased from 10.4% to 3.2% on 24-h pH monitoring. The mean pressure of the lower esophageal sphincter improved from 8.1 to 12.3 mmHg. Esophagitis healed in 63 of 66 patients in whom it was present prior to surgery. The overall Quality of Life Index improved significantly from 86 +/- 16 to 116 +/- 16. CONCLUSION: Laparoscopic fundoplication provides effective and durable relief of reflux in patients with GERD. The Quality of Life Index showed significant improvement after surgery.     

腹腔镜Nissen胃底折叠术治疗胃食管反流病安全性的Meta分析

目的评价腹腔镜Nissen胃底折叠术（LNF）治疗胃食管反流病（GERD）的安全性。方法计算机检索MEDLINE、EMBASE、PubMed、CBM、CNKI及Cochrane图书馆;手工检索有关中文杂志。纳入LNF与传统开腹Nissen底折叠术（ONF）治疗GERD的前瞻性随机对照试验（RCT）,用RevMan4．2．2软件进行统计分析。结果共纳入6个RCT,包括442例患者,无一例术后死亡病例,Meta分析结果显示,LNF与ONF相比手术并发症发生率低,差异有统计学意义（P〈0．05）。结论与ONF相比LNF治疗GERD有更高的手术安全性,尚有待进一步开展大样本高质量的RCT予以证实。     

Perioperative outcome of esophageal fundoplication for gastroesophageal reflux disease in obese and morbidly obese patients

Background

To determine the perioperative safety of esophageal fundoplication for gastroesophageal reflux disease (GERD) in patients with body mass index (BMI) ≥35 kg/m².

Methods

A retrospective review of 4,231 patients who underwent fundoplication for GERD from 2005 to 2009 was performed. Patients were identified via National Surgical Quality Improvement Program and grouped by BMI < 35 versus BMI ≥ 35 kg/m². Univariate analysis compared 30-day outcomes.

Results

Of the 4,231 patients, 3,496 (83%) had BMI < 35 kg/m² and 735 (17%) had BMI ≥ 35 kg/m². Mean BMI for each cohort was 27.9 versus 39.1, respectively. Patients with BMI ≥ 35 kg/m² had significantly longer operative times (129.7 vs 118 minutes, P < .0001) and increased American Society of Anesthesiologists scores (2.43 vs 2.3, P = .001). The overall complication rate was 1.96%. No difference was demonstrated by BMI in complication rate or hospital length of stay. Increased American Society of Anesthesiologists score, diabetes, black race, longer operative time, and intraoperative transfusion significantly increased postoperative complication rates.

Conclusions

No increased risk is conferred to morbidly obese patients who undergo fundoplication for GERD management. This study identified independent patient risk factors for postoperative complication following esophageal fundoplication.     

腹腔镜Nissen胃底折叠术治疗老年重度胃食管反流病的长期疗效观察

目的通过对老年重度胃食管反流病(gasroesophageal reflux disease,GERD)患者行腹腔镜Nissen胃底折叠术(laparoscopic Nissen fundoplication,LNF)的长期随访结果和对照组对比分析,评价该方法远期的安全性和有效性。 方法回顾分析自2005年1月至2011年1月因重度GERD行LNF治疗的老年患者21例,与同期对照组44例对比,分析两组患者的远期治疗效果。 结果两组患者均成功行LNF治疗,术后早期症状均获得缓解,手术时间和术后短期并发症两组比较无明显差异,术后胃镜见食管炎症状均较术前有所好转。术后平均随访7.4年,两组复发率比较无统计学差异,老年组远期吞咽困难发生率高于对照组。 结论LNF治疗老年重度GERD安全、有效,但远期吞咽困难发生率较高于对照组。     

Long-term comparative outcome between laparoscopic total Nissen and Toupet fundoplication: Symptomatic relief,patient satisfaction and quality of life

Background Laparoscopic antireflux surgery has become an established method of treatment of gastroesophageal reflux disease. This study compares the long-term outcome of total (Nissen) and partial (Toupet) fundoplication, performed in a single institution, by evaluating symptoms and quality of life. Methods 266 patients who underwent laparoscopic Nissen or Toupet fundoplication completed a preoperative reflux symptom questionnaire. Postsurgery symptom evaluation, patient satisfaction and quality of life in reflux and dyspepsia (QOLRAD) questionnaires were sent to these patients in December 2004. The two groups were compared for each item nonparametrically. Results Completed questionnaires were received from 161 patients (61%) of whom 99 had a laparoscopic Nissen fundoplication and 62 laparoscopic Toupet fundoplication. Both procedures were equivalent in improving reflux symptom scores in the long term, 79/99 (80%) and 56/62 (90%) were either symptom free or had obtained significant symptomatic relief. Both groups had equivalent QoL scores on the QOLRAD questionnaire. An equivalent number of patients (86% and 83.9% after Nissen and Toupet, respectively) were sufficiently satisfied to recommend antireflux surgery to a friend or relative complaining of reflux symptoms. Conclusion In conclusion, in patients who have returned the questionnaire, long-term satisfaction, general symptom scores, and quality of life are equivalent after laparoscopic Nissen (complete) or Toupet (partial) fundoplication. There is however, a significant increased prevalence of persistent heartburn after laparoscopic Toupet fundoplication.     

Transthoracic Nissen fundoplication for gastroesophageal reflux in patients with severe kypho-roto-scoliosis

Transthoracic Nissen fundoplication was used for the correction of gastroesophageal reflux in five mentally retarded patients with severe kypho-roto-scoliosis. This deformity may result in a gastroesophageal junction so high above the left costal margin that transabdominal fundoplication is extremely difficult. Operative morbidity was minimal. One wrap disruption occurred that required reoperation. Results have been satisfactory 6 to 24 months postoperatively.     

腹腔镜Nissen胃底折叠术治疗胃食管反流病

目的 探讨腹腔镜Nissen胃底折叠术治疗胃食管反流病的效果.方法 对近2年来收治的109例胃食管反流病实施腹腔镜Nissen胃底折叠术患者的临床资料进行回顾性分析.结果 108例成功完成手术.1例因难以控制的脾上极胃短血管出血而中转开腹.手术用时30-245(平均68.1)min,术中出血5～450(平均30.0)mL;术后住院天数2～8(平均4.2)天.术后102例获3～27个月的随访,7例失访.随访患者中99例(97.1%)反酸、烧心等消化道症状基本消失,2例(2.0%)明显缓解,1例(0.9%)无效.术后2例出现较严重的吞咽困难,1例严重上腹胀气,2例腹泻,1例出现术后食管裂孔疝.结论 腹腔镜Nissen胃底折叠术是治疗胃食管反流病的一种微创、安全、有效的治疗方法.     

Laparoscopic Nissen fundoplication improves quality of life in patients with atypical symptoms of gastroesophageal reflux

Laparoscopic Nissen fundoplication has been shown to improve overall quality of life (QOL) in patients with gastroesophageal reflux, but most studies have not addressed patients with atypical symptoms. We investigated the effect of laparoscopic Nissen fundoplication on QOL using the Gastrointestinal Quality of Life Index (GIQLI) survey modified to address both typical (heartburn, regurgitation, dysphagia) and atypical (hoarse voice, chronic cough, adult-onset asthma, vocal cord polyps) symptoms. One-hundred forty-eight patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) at UCLA Medical Center from January 1, 1995 to May 1, 2002. Surveys evaluating pre- and postoperative QOL were administered after surgery: 55 per cent of patients responded (82/148). Forty-eight per cent of all patients (72/148) had atypical symptoms. Perioperative morbidity and mortality were 8.8 per cent and 0.7 per cent, respectively. Mean length of postoperative stay was 2.96 +/- 1.5 days. Mean follow-up for the entire cohort was 18.5 months. Postoperative dysphagia not present before surgery occurred in 4.7 per cent of patients. Eighty per cent of patients were medication-free following surgery. QOL scores for all participants increased significantly from 52.5 +/- 15.3 preoperatively to 72.0 +/- 14.9 postoperatively (P < 0.0001). Patients with atypical symptoms or typical symptoms alone showed significant mean QOL score increases from 48.3 +/- 17.6 preoperatively to 71 +/- 15.7 postoperatively (P < 0.0001) and from 55.7 +/- 12.6 to 72.8 +/- 14.4 (P < 0.0001), respectively. Laparoscopic Nissen fundoplication can effectively improve overall QOL for patients with GERD. Patients with atypical GERD symptoms can experience increases in QOL similar to those with only typical gastrointestinal symptoms.     

腹腔镜Nissen胃底折叠联合His角重建术治疗胃食管反流病的短期疗效

目的探讨腹腔镜Nissen胃底折叠术联合His角重建治疗胃食管反流病（GERD）的效果。 方法回顾性分析2018年10月至2021年2月于首都医科大学宣武医院普通外科接受Nissen胃底折叠（360°）+His角重建术和单纯Nissen胃底折叠术GERD患者的临床资料,观察比较两种术式抗反流效果的差异、患者对手术治疗满意度等情况。 结果本研究共纳入GERD患者98例,其中Nissen+His角重建组为52例,Nissen组为46例。术后6个月时,2组患者GERD相关症状（食管症状：反流、胃灼热、胸背痛及剑突下顶胀感。食管外症状：咳嗽、喘息、咽部异物感）评分均显著低于治疗前（P<0.05）。术后症状评分中,Nissen+His角重建组反流、胃灼热症状评分低于Nissen组,差异有统计学意义（反流：Z=－2.466,P=0.014;胃灼热：Z=－2.674,P=0.007）;2组其他症状评分差异均无统计学意义（P>0.05）。2组术后功能性并发症（包括吞咽困难、腹胀、难以嗳气、排气增多及慢性腹部疼痛）发生率相似,经保守治疗均获得明显缓解。Nissen+His角重建组患者对手术治疗满意度为94.2%（49/52）,Nissen组患者满意度为91.3%（42/46）,2组患者手术满意度差异无统计学意义（P=0.866）。 结论Nissen胃底折叠+His角重建术与Nissen胃底折叠术均有较好的抗反流疗效,手术并发症少、轻微,患者满意度高。与Nissen组相比,Nissen+His角重建组控制反流、胃灼热症状更佳,该结果需要前瞻性、大样本、长期随访结果予以证实。     

腹腔镜食管裂孔疝修补术并胃底折叠术对患者生存质量的影响

目的:探讨腹腔镜食管裂孔疝修补术并胃底折叠术对患者生存质量的影响。方法:采用消化病生存质量指数(gastrointestinal Lebens qualities index,GLQI)前瞻性地测定29例患者行腹腔镜食管裂孔疝修补术和胃底折叠术前,术后2周、1个月、3个月、6个月的生存质量值,并进行临床分析。结果:术前患者GLQI指数平均(83.62±13.14),明显低于正常人群(121～125分);术后2周平均(86.76±10.16),较术前有所升高,差异无统计学意义(P>0.05),但患者精神、心理较术前改善(P<0.05);术后1个月、3个月平均为(106.83±8.40)及(113.35±8.54),较术前及术后2周明显升高,差异有统计学意义(P<0.05);术后6个月平均(121.45±5.96),接近或达到正常水平。结论:腹腔镜食管裂孔疝修补术和胃底折叠术可提高患者术后生存质量,使其生存质量接近或达到正常人水平。     

开腹手术与腹腔镜手术治疗结直肠癌的远期疗效及患者生活质量的对比研究

目的:比较开腹手术与腹腔镜手术治疗结直肠癌的远期疗效及对患者生活质量的影响。方法:选择2009年7月至2011年6月收治的157例结直肠癌患者,采用χ~2检验、Kaplan-Meier曲线法、Log rank检验及Student’s t检验比较腹腔镜组与开腹组的术后并发症、肿瘤复发率、5年生存率(期)及生活质量。结果:并发症严重程度两组差异有统计学意义(Z=8.243,P=0.023),腹腔镜组更轻、开腹组更重;两组肿瘤复发率及复发类型差异无统计学意义(P0.05);腹腔镜组5年总生存率为38.03%,中位生存时间为41个月,开腹组为46.51%及43个月,两组相比差异无统计学意义(Log rankχ~2=0.749,P=0.387,HR=0.823,95%CI:0.523-1.296)。腹腔镜组Karnofsky评分显著高于开腹组(t=2.305,P=0.022)。结论:虽然与开腹手术相比,腹腔镜手术并不能显著延长患者生存期、提高5年生存率,但其并发症更轻,患者生活质量更好,临床可优先考虑选择腹腔镜治疗可手术的结直肠癌。     

Failure of the Nissen fundoplication to control gastroesophageal reflux in esophageal atresia patients

During the 5-year period from 1981 to 1985, Nissen fundoplication was performed on 13 esophageal atresia patients. One patient with Down's syndrome died because of cardiac malformation 2 weeks after the operation and is excluded from the analysis. Nine of the remaining 12 patients had the usual malformation with distal fistula, while three had isolated atresia. In eight patients there was a long gap between the segments, and in five Livaditis myotomy was necessary. The median age of the patients at the fundoplication was 1.3 years (range, 4.5 months to 10.6 years). The main clinical manifestations were anastomotic stricture (six patients), respiratory complications (three patients), vomiting and difficulties in feeding (two patients), and esophagitis only (one patient). Altogether nine patients had preoperative distal esophagitis. Mean follow-up time was 4.1 years (range, 2.0 to 6.4 years). All patients primarily benefited from the operation. Routine control endoscopy 3 to 8 months after the operation showed a competent fundoplication in all patients. However, in five patients the reflux later recurred, and endoscopy revealed a partially disrupted fundal wrap and esophagitis. Four patients underwent refundoplication and one is waiting for it as of this writing. Four patients had Barrett's esophagus at the last endoscopic control. There was one late death due to cardiac failure. In conclusion, although the short-term results of Nissen fundoplication in esophageal atresia patients are good, the risk for late recurrence is high. Regular long-term follow-up is therefore necessary.     

腹腔镜胃底折叠术治疗胃食管反流病372例

目的 探讨腹腔镜胃底折叠术治疗胃食管反流病(GERD)的可行性和临床应用价值.方法 2005年9月至2010年8月,对372例GERD病人实施腹腔镜胃底折叠术,其中Nissen胃底折叠术146例,Toupet胃底折叠术79例,前180°胃底折叠术147例,记录围手术期相关指标,随访观察治疗效果.结果 372例均完成腹腔镜手术,无中转开腹者.手术时间50～210 min,平均85 min;术中出血40～150 ml,平均86 ml.术后住院3～21天,平均4.3天.术后临床症状均得到缓解,无严重并发症及死亡病例.术后3个月复查胃镜、上消化道造影、食管测压和24 h食管pH检测均恢复正常.350例随访～63个月,平均27.3个月,对手术效果满意率92.57%,19例有进固体食物时轻度梗噎感,6例反酸症状复发,使用抑酸药物可控制,1例食管裂孔疝复发.结论 腹腔镜胃底折叠术治疗中、重度GERD充分体现了微创手术创伤小、恢复快、安全可行、疗效可靠的特点;3种胃底折叠方式根据病人具体情况应用,能够最大限度地保证手术效果、降低操作难度,减少术后并发症.

Abstract：

Objective To investigate the feasibility and clinical value of laparoscopic surgery in treating patients with gastroesophageal reflux disease. Methods From September 2001 to August 2009, 372 patients with gastroesophageal reflux disease undertwent laparoscopic fundoplication, including 146 cases of Nissen fundoplication, 79 Toupet fundoplication, and 147 anterior 180 degrees partial fundoplication. Para-operative clinical parameters were recorded. All patients were routinely followed up. Clinical outcomes were collected and analyzed. Results Laparoscopic surgery was successfully performed in all patients, and no conversions were required. The operating time was 50 -210 minutes (mean, 85 minutes), the operative blood loss was 40 - 150 ml( mean, 86 ml) ,the postoperative hospital stay was 3 - 21 days( mean, 4.3 days ). The symptoms in most cases were adequately relieved after operation. There were no severe postoperative morbidity and mortality. Endoscopy, radiology, esophageal manometry and 24-hour pH monitoring were repeated 3 months after surgery. After the follow-up period of 3 -63 months ( mean, 27.3 months), the satisfaction rate of operation was 92.57%. 19 cases had mild dysphagia when eating solid food. Symptoms recurrence of acid reflux occurred in 6 cases, which were controlled by antacid medications. Hiatal hernia recurrence occurred in 1 case. Conclusions Laparoscopic operation should be the method of choice to treat the moderate to severe gastroesophageal reflux disease, with the advantages of minimized trauma,quick recovery, safety,feasibility and reliable effect. According to individual condition of patients, appropriate fundoplication procedure should be employed carefully to ensure results of operations, reduce operating difficulties and the rate of postoperative complications.     

Risk factors for recurrent gastroesophageal reflux disease after fundoplication in pediatric patients: a case-control study

Background/Purpose

Recurrent gastroesophageal reflux disease (rGERD) is a common problem after fundoplication. Previous studies attempting to identify risk factors for rGERD have failed to control for confounding variables. The purpose of this study was to identify significant risk factors for rGERD after controlling for potential confounding variables.

Methods

A retrospective, matched case-control study was conducted at a tertiary children's hospital. Cases (n = 116) met 1 of these criteria: reoperation for rGERD, symptomatic rGERD (confirmed by upper gastrointestinal series, esophagogastroduodenoscopy, or pH monitoring), or postoperative reinstitution of antireflux medication for more than 8 weeks. Controls (n = 209) were matched for surgeon, approach (laparoscopic/open), technique (partial/complete), and approximate operative date. Univariate and multivariable associations were analyzed by conditional logistic regression.

Results

Significant risk factors for rGERD were age of less than 6 years (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.7-7.5), preoperative hiatal hernia (OR, 3.2; 95% CI, 1.4-7.3), postoperative retching (OR, 5.1; 95% CI, 2.6-10.0), and postoperative esophageal dilatation (OR, 10.8; 95% CI, 1.8-65.4). Interestingly, significant association was not found between neurologic impairment and rGERD after controlling for potential confounding variables.

Conclusion

Age of less than 6 years, preoperative hiatal hernia, postoperative retching, and postoperative esophageal dilatation are independently associated with increased risk of rGERD. Neurologic impairment alone does not increase the risk of developing rGERD.