Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication

被引:3
|
作者
Park, Sangjun [1 ]
Park, Shin-Hoo [1 ,3 ]
Kim, Min Seo [7 ]
Kwak, Jisoo [4 ]
Lee, Inhyeok [1 ,3 ]
Kwon, Yeongkeun [3 ]
Lee, Chang Min [8 ]
Choi, Hyuk Soon [5 ]
Keum, Bora [5 ]
Yang, Kyung-Sook [2 ]
Park, Joong-Min [6 ]
Park, Sungsoo [1 ,3 ]
机构
[1] Korea Univ, Dept Surg, Coll Med, Seoul, South Korea
[2] Korea Univ, Dept Biostat, Coll Med, Seoul, South Korea
[3] Korea Univ, Dept Surg, Div Foregut Surg, Anam Hosp, Seoul, South Korea
[4] Korea Univ, Dept Anesthesiol & Pain Med, Anam Hosp, Seoul, South Korea
[5] Korea Univ, Dept Internal Med, Div Gastroenterol & Hepatol, Anam Hosp, Seoul, South Korea
[6] Chung Ang Univ, Dept Surg, Coll Med, Seoul, South Korea
[7] Sungkyunkwan Univ, Samsung Adv Inst Hlth Sci & Technol SAIHST, Genom & Digital Hlth, Seoul, South Korea
[8] Korea Univ, Dept Surg, Div Foregut Surg, Ansan Hosp, Ansan, South Korea
关键词
gastroesophageal reflux disease; high-resolution esophageal manometry; laparoscopic fundoplication; lower esophageal sphincter; GASTROESOPHAGEAL-REFLUX DISEASE; ESOPHAGEAL SPHINCTER PRESSURE; ANTIREFLUX SURGERY; RESPIRATORY SYMPTOMS; CLINICAL-OUTCOMES; MANAGEMENT; PH; GUIDELINE; LENGTH; SATISFACTION;
D O I
10.1097/JS9.0000000000000274
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Currently, the reported parameters that predict the resolution of symptoms after surgery are largely subjective and unreliable. Considering that fundoplication rebuilds the structural integrity of the lower esophageal sphincter (LES), the authors focused on searching for objective and quantitative predictors for the resolution of symptoms based on the anatomical issues and whether an antireflux barrier can be well established or not. Materials and methods: The authors reviewed the prospectively collected data of 266 patients with gastroesophageal reflux disease (GERD) who had undergone laparoscopic Nissen fundoplication (LNF). All patients were diagnosed with GERD using preoperative esophagogastroduodenoscopy, 24-h ambulatory esophageal pH monitoring, and high-resolution esophageal manometry. The patients received GERD symptom surveys using the validated Korean Antireflux Surgery Group questionnaire twice: preoperatively and 3 months after the surgery. Results: After excluding patients with insufficient follow-up data, 152 patients were included in the analysis. Multivariate logistic regression analyses revealed that a longer length of the LES and lower BMI determined better resolution of typical symptoms after LNF (all P < 0.05). Regarding atypical symptoms, higher resting pressure of LES and DeMeester score greater than or equal to 14.7 were associated with better resolution after the surgery (all P < 0.05). After LNF, typical symptoms improved in 34 out of 37 patients (91.9%) with a length of LES > greater than.05 cm, BMI less than 23.67 kg/m(2), and atypical symptoms were resolved in 16 out of 19 patients (84.2%) with resting pressure of LES greater than or equal to 19.65 mm Hg, DeMeester score greater than or equal to 14.7. Conclusion: These results show that the preoperative length and resting pressure of LES is important in the objective prediction of symptom improvement after LNF.
引用
收藏
页码:1239 / 1248
页数:10
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