Predictors of objectively identified recurrent reflux after primary Nissen fundoplication

被引:16
作者
Broeders, J. A. J. L. [1 ]
Roks, D. J. G. H. [1 ]
Draaisma, W. A. [1 ]
Vlek, A. L. M. [2 ]
Hazebroek, E. J. [1 ]
Broeders, I. A. M. J. [3 ]
Smout, A. J. P. M. [4 ]
机构
[1] Univ Med Ctr Utrecht, Dept Surg, Gastrointestinal Res Unit, NL-3508 GA Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Dept Epidemiol, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands
[3] Meander Med Ctr, Dept Surg, Amersfoort, Netherlands
[4] Univ Amsterdam, Acad Med Ctr, Dept Gastroenterol & Hepatol, NL-1105 AZ Amsterdam, Netherlands
关键词
RANDOMIZED-CLINICAL-TRIAL; INEFFECTIVE ESOPHAGEAL MOTILITY; LONG-TERM OUTCOMES; GASTROESOPHAGEAL-REFLUX; LAPAROSCOPIC FUNDOPLICATION; ANTIREFLUX SURGERY; DISEASE; AGE; CLASSIFICATION; ABNORMALITIES;
D O I
10.1002/bjs.7411
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Laparoscopic Nissen fundoplication is the most frequently performed operation for gastro-oesophageal reflux disease (GORD). Studies on predictors of subjective outcome of fundoplication have yielded inconsistent results. This study identified predictors of objective reflux control after Nissen fundoplication. Methods: This was a retrospective analysis of prospectively collected data from patients who underwent Nissen fundoplication for proton pump inhibitor-refractory GORD with pathological acid exposure in a single centre between 1997 and 2005. The predictive value of demographics, endoscopic hiatal hernia size, oesophagitis, lower oesophageal sphincter pressure, distal oesophageal contraction amplitude, percentage of peristaltic contractions and acid exposure was determined. Endpoints were recurrent pathological acid exposure on 24-h pH monitoring at 6 months and surgical reintervention for recurrent GORD up to 6 years. Results: Of 177 patients, 22 had recurrent pathological acid exposure at 6 months for which 11 had surgery within 6 years. Only low percentage of peristaltic contractions (odds ratio (OR) 0.97, 95 per cent confidence interval 0.95 to 0.99; P = 0.004) and high supine acid exposure (OR 1.03, 1.00 to 1.07; P = 0.025) were independent predictors of recurrent pathological acid exposure. The absolute risk of recurrent exposure was 45.5 per cent in patients with both predictors. High supine acid exposure was also an independent predictor of surgical reintervention (OR 1.05, 1.01 to 1.08; P = 0.006). Conclusion: Nissen fundoplication should not necessarily be withheld from patients with poor oesophageal peristalsis or excessive supine acid exposure. As about half of patients with both variables experience recurrent pathological acid exposure after primary Nissen fundoplication, surgery should be restricted in this group.
引用
收藏
页码:673 / 679
页数:7
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