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1.
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。 相似文献
2.
Gabor Varga Agnes Kiraly Laszlo Cseke Katalin Kalmar Ors Peter Horvath 《Journal of gastrointestinal surgery》2008,12(2):304-307
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. 相似文献
3.
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。 相似文献
4.
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 相似文献
5.
Therapeutic Effects of Laparoscopic Fundoplication for Nonerosive Gastroesophageal Reflux Disease 总被引:1,自引:0,他引:1
Omura N Kashiwagi H Yano F Tsuboi K Ishibashi Y Kawasaki N Suzuki Y Yanaga K 《Surgery today》2006,36(11):954-960
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. 相似文献
6.
Reginald V. N. Lord Steven R. DeMeester Jeffrey H. Peters Jeffrey A. Hagen Dino Elyssnia Corinne T. Sheth Tom R. DeMeester 《Journal of gastrointestinal surgery》2009,13(4):602-610
Background and Aims Gastroesophageal reflux disease (GERD) is a spectrum of disease that includes nonerosive reflux disease (NERD), erosive reflux
disease (ERD), and Barrett’s esophagus (BE). Treatment outcomes for patients with different stages have differed in many studies.
In particular, acid suppressant medication therapy is reported to be less effective for treating patients with NERD and Barrett’s
esophagus. The aims of this study were to investigate (1) the role of mechanical factors including hiatal hernia and lower
esophageal sphincter (LES) competence in the spectrum of GERD and (2) outcomes of Nissen fundoplication.
Methods From the records of patients who had undergone laparoscopic Nissen fundoplication after an abnormal pH study, we identified
50 symptomatic consecutive patients with each of the GERD stages: (1) NERD, (2) mild ERD, defined as esophagitis that was
healed with acid suppression therapy, (3) severe ERD, defined as esophagitis that persisted despite medical therapy, and (4)
BE. Exclusion criteria were normal distal esophageal acid exposure, esophageal pH monitoring performed elsewhere, antireflux
surgery less than 1 year previously or previous fundoplication, and a named esophageal motility disorder or distal esophageal
low amplitude hypomotility. Patients who could not be contacted for the study were also excluded. All patients completed a
detailed preoperative questionnaire; underwent preoperative upper gastrointestinal endoscopy, stationary manometry, and distal
esophageal pH monitoring; and were interviewed at least 1 year after operation.
Results One hundred sixty patients meeting the entry criteria were studied. The mean follow-up period was 36.7 months. The only significant
preoperative symptom difference was that patients with BE had more moderately severe or severe dysphagia compared to patients
with NERD. Patients with severe ERD or BE had a significantly higher prevalence of hiatal hernia, lower LES pressures, and
more esophageal acid exposure. Hiatal hernia and hypotensive LES were present in most patients with severe ERD or BE but in
only a minority of patients with NERD or mild ERD. Surgical therapy resulted in similarly excellent symptom outcomes for patients
in all GERD categories.
Conclusions Compared to mild ERD and NERD, severe ERD and BE are associated with significantly greater loss of the mechanical antireflux
barrier as reflected in the presence of hiatal hernia and LES measurements. Restoration of the antireflux barrier and hernia
reduction by laparoscopic Nissen fundoplication provides similarly excellent symptom control in all patients. 相似文献
7.
Robert A. Catania Stephen M. Kavic J. Scott Roth Tommy H. Lee Tanya Meyer George T. Fantry Paul F. Castellanos Adrian Park 《Journal of gastrointestinal surgery》2007,11(12):1579-1588
Introduction The utility of laparoscopic Nissen fundoplication in the treatment of laryngopharyngeal reflux symptoms remains controversial.
We hypothesized that a carefully selected population with these symptoms would benefit from antireflux surgery.
Materials and Methods Sixty-one consecutive patients have undergone antireflux surgery for laryngopharyngeal reflux at a single institution. Preoperative
evaluation including upper endoscopy, laryngoscopy, and 24-h ambulatory pharyngeal pH probe monitoring confirmed the diagnosis.
Patients completed two validated symptom assessment instruments preoperatively and at multiple time points postoperatively.
Results Patients were followed for up to 3 years with a mean follow-up of 15.2 months. A significant improvement in reflux symptom
index score (preoperative = 31.5 ± 7.4 vs 3 years = 12.4 ± 10.9, p < 0.01), laryngopharyngeal reflux health-related quality of life overall score (preoperative = 55.0 ± 26.0 vs 3 years = 11.3 ± 13.9,
p < 0.01), and symptom domain scores (voice, cough, throat clearing, and swallowing) occured within 1 month of surgery and
remained improved over the course ofthe study.
Conclusion Laparoscopic Nissen fundoplication is effective in relieving the symptoms of laryngopharyngeal reflux in a carefully selected
patient population. Benefits are seen within 1 month of surgery and persist for at least 3 years.
Presented at the Digestive Disease Week 2007, May 22, 2007, Washington, DC. 相似文献
8.
腹腔镜Nissen胃底折叠术治疗胃食管反流病110例报告 总被引:1,自引:0,他引:1
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。 相似文献
9.
It is sometimes difficult or inappropriate to adopt the standard surgical steps of adult laparoscopic procedures in pediatric patients because of the inevitably smaller anatomical structures and confined intra-abdominal working space. During laparoscopic Nissen fundoplication difficulties are usually encountered, especially when dissecting the diaphragmatic crura, creating the retroesophageal window, and repairing the crura. Thus, we devised a technique to accomplish these steps in pediatric patients. Both crural dissection and repair are approached from the left side of the esophagus and the port configuration for the laparoscope and other instruments is altered, providing better surgical exposure and easier handing of the instruments, even in very small patients. We describe this technique in detail and our results. 相似文献
10.
C.S. Davis A. Baldea J.R. Johns R.J. Joehl P.M. Fisichella 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(3):332-341
Background:
For nearly 2 decades, the laparoscopic correction of gastroesophageal reflux disease (GERD) has demonstrated its utility. However, the surgical technique has evolved over time, with mixed long-term results. We briefly review the evolution of antireflux surgery for the treatment of GERD, provide an update specific to the long-term efficacy of laparoscopic antireflux surgery (LARS), and analyze the factors predictive of a desirable outcome.Materials and Methods:
PubMed and Medline database searches were performed to identify articles regarding the laparoscopic treatment of GERD. Emphasis was placed on randomized control trials (RCTs) and reports with follow-up >1 year. Specific parameters addressed included operative technique, resolution of symptoms, complications, quality of life, division of short gastric vessels (SGVs), mesh repair, and approximation of the crura. Those studies specifically addressing follow-up of <1 year, the pediatric or elderly population, redo fundoplication, and repair of paraesophageal hernia and short esophagus were excluded.Results:
LARS has varied in technical approach through the years. Not until recently have more long-term, objective studies become available to allow for evidenced-based appraisals. Our review of the literature found no long-term difference in the rates of heartburn, gas-bloat, antacid use, or patient satisfaction between laparoscopic Nissen and Toupet fundoplication. In addition, several studies have shown that more patients had an abnormal pH profile following laparoscopic partial as opposed to total fundoplication. Conversely, dysphagia was more common following laparoscopic total versus partial fundoplication in 50% of RCTs at 12-month follow-up, though this resolved over time, being present in only 20% with follow-up >24 months. We confirmed that preoperative factors, such as hiatal hernia, atypical symptoms, poor antacid response, body mass index (BMI), and postoperative vomiting, are potential predictors of an unsatisfactory long-term outcome. Last, no trial disfavored division of the short gastric vessels (SGVs), closure of the crura, or mesh repair for hiatal defects.Conclusion:
LARS has significantly evolved over time. The laparoscopic total fundoplication appears to provide more durable long-term results than the partial approach, as long as the technical elements of the operation are respected. Division of the SGVs, closure of the crura, and the use of mesh for large hiatal defects positively impacts long-term outcome. Hiatal hernia, atypical symptoms, poor antacid response, body mass index (BMI), and postoperative vomiting are potential predictors of failure in LARS. 相似文献11.
Introduction
Nissen fundoplication has been performed laparoscopically for over 15 years, being associated with shorter hospital stay and
fewer complications than conventional open surgery with good long-term outcomes. Day-case laparoscopic Nissen fundoplication
(LNF) is rarely performed in the UK and most series in the literature report length of stay >2 days.
Methods
The objective of this study was to examine the safety and efficacy of day-case LNF. The clinical records of all patients undergoing
LNF under the care of three surgeons in a district general hospital (DGH) during a 5-year period (January 2003 to December
2007) were reviewed to examine length of stay, complications, length of procedure, grade of operating surgeon and symptoms
on follow-up.
Results
One hundred thirteen day-case LNFs were recorded in this series. Day-case LNF patients had median age of 45 years (range 20–68 years,
65% (64.6%) male) and 98% were American Society of Anesthesiologists (ASA) grade I or II. Twenty-one cases (19%) were performed
by higher surgical trainees. Median operative time was 54 minnutes (range 25–120 min). Only one perioperative complication
(port-site bleed) occurred, treated without prolonging length of stay. The proportion of all LNF performed as day cases increased
from 8% to 52% during the study period. Median operative time has significantly reduced from the first 20 consecutive LNF
cases to the latest 20 cases [65 min (range 40–120 min) versus 48 min (range 25–72 min); p = 0.037]. At follow-up (median 7 weeks, range 2–31 weeks) 82% of patients had improvement in all presenting symptoms. Eight
patients had postoperative complications [wound infection (n = 2), persistent regurgitation requiring laparoscopic division of a gastric band adhesion (n = 1), dysphagia (n = 5 with two patients requiring redo partial fundoplication and one patient requiring dilatation) and there were no conversions
to open surgery.
Conclusion
Day-case LNF is safe and effective for treating selected patients with gastroesophageal reflux disease (GERD) in a DGH. The
proportion of day-case LNFs is increasing in our unit. Half of the LNFs in a DGH can be done as day cases. Experience is associated
with a significant reduction in operative time. 相似文献
12.
Rothenberg SS 《Surgical endoscopy》2006,20(10):1518-1520
From January 1994 to December 2004, 118 patients with recurrent gastroesophageal reflux disease (GERD) after fundoplication
underwent laparoscopic redo Nissen fundoplication. The patients ranged in age from 6 months to 19 years (mean, 7 years), and
weighed from 6.4 to 85 kg. Of the 118 patients, 64 had previous open fundoplications, 53 had previous laparoscopic fundoplications,
and 19 had more than one previous fundoplication. All the procedures had been successfully completed laparoscopically. The
average operative time was 100 min. The intraoperative complication rate was 1.1%. The average time to full feeding was 1.8
days, and the average hospital stay was 2.2 days. The postoperative complication rate was 3.6%. The wrap failure rate during
an average follow-up period of 48 months was 6%. Laparoscopic redo Nissen fundoplication for a failed antireflux procedure
is a safe and effective procedure. It has the same benefits as a primary laparoscopic Nissen for GERD, with low morbidity
and a quicker recovery. Early follow-up evaluation suggests that the long-term outcome is superior to that associated with
open redo fundoplication. 相似文献
13.
Paul F. Hwang Karen A. Ospina Earl H. Lee Scott R. Rehring 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2012,16(2):301-305
Background & Objectives:
Chyloascites is a rare complication that can result from abdominal trauma, neoplasm, inflammatory conditions, or various abdominal surgeries. Few cases have been described secondary to iatrogenic injury from laparoscopic Nissen fundoplication. We describe a case in which this surgery resulted in chyloascites that was successfully treated by lymphatic glue embolization.Methods:
A 37-year-old male presented with signs and symptoms consistent with chronic reflux disease. He underwent an uneventful laparoscopic Nissen fundoplication. Two weeks postoperatively, he was admitted for dehydration. During his admission, he began to develop a persistent cough, shortness of breath, and abdominal distention. Imaging and fluid analysis from thoracocentesis and paracentesis were consistent with chyle leakage. Despite nonoperative measures, the patient''s presentation persisted.Results:
Thoracic duct ligation was performed without success. Bipedal lymphangiography identified an extensive leak revealing a severely lacerated thoracic duct spilling contrast freely into the abdomen and no contrast entering the thoracic duct in the chest. The site of injury was successfully sealed off with percutaneous glue embolization through lymph channels.Conclusion:
Chyloascites is a rare complication of laparoscopic Nissen fundoplication. When not successful with conservative measures, lymphatic glue embolization can provide effective treatment. 相似文献14.
腹腔镜Nissen与Toupet胃底折叠术治疗胃食管反流性疾病的临床分析 总被引:4,自引:0,他引:4
目的 比较腹腔镜Nissen与Toupet胃底折叠术治疗胃食管反流性疾病(GERD)的优缺点及其适应证。方法 回顾分析2001年6月至2005年12月腹腔镜胃底折叠术后GERD的83例临床资料。其中65例行腹腔镜Nissen胃底折叠术,18例行腹腔镜Toupet胃底折叠术。结果 两组均无中转开腹及死亡病例。术后两组症状均完全消失。平均随访2.6年,Nissen组未出现症状复发,Toupet组2例病人症状复发,需服抑酸药物控制。术后4个月复查食道测压和酸反流的指标两组均在正常范围内。Nissen组食道炎症的治愈率为84.6%,Toupet组为66.7%。术后4d,Nissen组吞咽困难、腹胀的发生率明显高于Toupet组(分别为27.7%和16.7%);术后1年,两组之间的差别明显减小(分别为1.5%和0)。结论 Toupet胃底折叠术后短期内吞咽困难的发生率明显低于Nissen胃底折叠术,但随着术后恢复时间的延长,两者间差异明显减小。对中重度GERD应首选腹腔镜Nissen胃底折叠术,对高龄,术前检查提示食管蠕动功能明显减弱的病人,可考虑行腹腔镜Toupet胃底折叠术。 相似文献
15.
Gastroesophageal reflux disease (GERD) has a high prevalence worldwide. Recent reports have noted a high prevalence even in Asian countries. GERD significantly affects the quality of life and can present with a wide variety of symptoms. Not all reflux is acid, and non-acid reflux disease can be more difficult to diagnose and can lead to a variety of extra-esophageal symptoms. Although proton pump inhibitors (PPIs) are effective in the majority of patients, but they are not without side effects, and their effect often diminishes with time. For patients who do not desire to be on long-term PPIs or have incomplete symptom resolution with medication, various endoscopic and minimally invasive treatment modalities are now available. The etiology of GERD can be multifactorial including dysfunctional LES, presence of a hiatal hernia, and transient lower esophageal sphincter relaxations (TLESRs). We hence believe that the treatment should be individualized to the cause of the reflux. In the following review, we describe the etiology of reflux disease and attempt to lay a framework for the diagnosis and selection of patients for the various interventions available for treatment, along with their evidence base. 相似文献
16.
Laparoscopic surgery for the definitive treatment of gastroesophageal reflux (GOR) has become an accepted alternative to conventional techniques in adults. Although relatively rare, GOR in children represents an important clinical entity with symptoms including failure to thrive, nocturnal dyspnea, and vomiting. This paper details our experience in eight children who have undergone a laparoscopic Nissen fundoplication for failed medical treatment of severe GOR. Particular attention is paid to technical aspects of the procedure and the differences between adult and pediatric techniques are emphasized. The preliminary results suggest that a laparoscopic Nissen fundoplication is a safe procedure which significantly improves reflux symptoms in children and that these results are comparable to those obtained with conventional surgery. 相似文献
17.
Huiqi Yang David I. Watson Jamie Kelly Carolyn J. Lally Jennifer C. Myers Glyn G. Jamieson 《Journal of gastrointestinal surgery》2007,11(9):1126-1133
INTRODUCTION: The outcome after laparoscopic Nissen fundoplication can be assessed by either clinical symptoms or objective tests. Outcomes from objective tests are often held in higher regard than clinical data when determining the merits, or otherwise, of various antireflux surgery procedures. In this study, we sought to determine whether there is a relationship between postoperative symptoms and parameters measured by esophageal manometry to determine whether early postoperative esophageal manometry is a useful investigation for the routine assessment of post fundoplication outcome. METHODS: One hundred and forty-three patients who had undergone a laparoscopic Nissen fundoplication, clinical follow-up at 3 months and 5 years after surgery, and esophageal manometry at 3 months after fundoplication as part of routine follow-up in 1 of 5 clinical trials were studied. Nineteen of these patients also underwent manometry 5 years after fundoplication. Postoperative symptoms were prospectively determined by applying a standardized questionnaire, which assessed dysphagia, heartburn, bloat symptoms, and overall satisfaction using analog scales. Patients were classified into different groups according to the analog scores for clinical symptoms. Correlations between clinical and postoperative manometry outcomes were sought. RESULTS: No significant associations were found between parameters measured by esophageal manometry (lower esophageal sphincter resting and residual relaxation pressures, peristaltic amplitude and normal peristaltic propagation) and clinical parameters (dysphagia, heartburn, bloating, and overall satisfaction) for all time points -- 3 months postoperative manometry vs symptoms at 3 months and 5 years, 5 years postoperative manometry vs symptoms at 5 years, except for a weak (r = -0.17, p = 0.042) correlation between the percentage of successfully propagated swallows at 3 months and dysphagia for solids at 5 years. CONCLUSION: Postoperative esophageal manometry parameters at 3 months and 5 years after surgery were not associated with any clinically important differences in the postoperative symptoms of heartburn, dysphagia, bloat or with overall satisfaction with the surgical outcome. The routine use of esophageal manometry to assess the outcome after Nissen fundoplication does not predict clinical outcome. 相似文献
18.
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 相似文献
19.
Nicole E. Sharp John Vassaur F. Paul Buckley III 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2014,18(3)
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. 相似文献20.
Craig B. Morgenthal Matthew D. Shane Alessandro Stival Nana Gletsu Graham Milam Vickie Swafford John G. Hunter C. Daniel Smith 《Journal of gastrointestinal surgery》2007,11(6):693-700
Laparoscopic Nissen fundoplication (LNF) has become the most commonly performed antireflux procedure since its introduction
in 1991. There are few studies with greater than 5-year outcomes. Herein we report a series of 312 consecutive patients who
underwent primary LNF before 1996. Follow-up of more than 6 years was available in 166 patients, and the mean follow-up was
11 years (median 11.1 years, range 6.1–13.3 years). Prospective data collection included preoperative and current symptom
scores (scale 0 = none to 3 = severe), as well as the level of patient satisfaction and use of antireflux medications. Total
symptom score for each patient was summed from seven symptoms for a maximum value of 21. Heartburn and regurgitation were
the most improved symptoms; however, all symptoms were significantly improved (P < 0.01). The total symptom score at follow-up was 2.6 down from 7.5 at baseline, with a mean difference of −4.9 (range −12
to 3). The percentage of patients stating they would have the procedure again was 93.3%, and 70% were off daily antireflux
medications. Outcomes at a mean of 11 years after LNF are excellent, and the majority of patients had their symptoms resolved
or significantly improved and are satisfied with their results.
Presented at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, May 22, 2006, Los Angeles, CA 相似文献