Long-term results (6-10 years) of laparoscopic fundoplication

被引：53

作者：

Zaninotto, Giovanni ^{[1
]}

Portale, Giuseppe ^{[1
]}

Costantini, Mario ^{[1
]}

Rizzetto, Christian ^{[1
]}

Guirroli, Ernanuela ^{[1
]}

Ceolin, Martina ^{[1
]}

Salvador, Renato ^{[1
]}

Rampado, Sabrina ^{[1
]}

Prandin, Oberdan ^{[1
]}

Ruol, Alberto ^{[1
]}

Ancona, Ermanno ^{[1
]}

机构：

[1] Univ Padua, Sch Med, Clin Chirurg 3, Dept Med & Surg Sci, I-35128 Padua, Italy

来源：

JOURNAL OF GASTROINTESTINAL SURGERY | 2007年 / 11卷 / 09期

关键词：

gastroesophageal reflux disease; laparoscopic fundoplication; paraesophageal hernia;

D O I：

10.1007/s11605-007-0195-y

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Most papers report excellent results of laparoscopic fundoplication but with relatively short follow-up. Only few studies have a follow-up longer than 5 years. We prospectively collected data of 399 consecutive patients with gastroesophageal reflux disease (GERD) or large paraesophageal/mixed hiatal hernia who underwent laparoscopic fundoplication between January 1992 and June 2005. Preoperative work-up included symptoms questionnaire, videoesophagogram, upper endoscopy, manometry, and pH-metry. Postoperative clinical/functional studies were performed at 1, 6, 12 months, and thereafter every other year. Patients were divided into four groups: GERD with nonerosive esophagitis, erosive esophagitis, Barrett's esophagus, and large paraesophageal/mixed hiatal hernia. Surgical failures were considered as follows: (1) recurrence of GERD symptoms or abnormal 24-h pH monitoring; (2) recurrence of endoscopic esophagitis; (3) recurrence of hiatat hernia/slipped fundoplication on endoscopy/barium swallow; (4) postoperative onset of dysphagia; (5) postoperative onset of gas bloating. One hundred and forty-five patients (87 M:58 F) were operated between January 1992 and June 1999: 80 nonerosive esophagitis, 29 erosive esophagitis, 17 Barrett's esophagus, and 19 large paracsophageal/mixed hiatal hernias. At a median follow-up of 97 months, the success rate was 74% for surgery only and 86% for primary surgery and 'complementary' treatments (21 patients: 13 redo surgery and eight endoscopic dilations). Dysphagia and recurrence of reflux were the most frequent causes of failure for nonerosive esophagitis patients; recurrence of hernia was prevalent among patients with large paraesophageal/mixed hiatal hernia. Gas bloating (causing failure) was reported by nonerosive esophagitis patients only. At last follow-up, 115 patients were off 'proton-pump inhibitors'; 30 were still on medications (eight for causes unrelated to GERD). Conclusion confirms that laparoscopic fundoplication provides effective, long-term treatment of gastroesophageal reflux disease. Hernia recurrence and dysphagia are its weak points.

引用

页码：1138 / 1145

页数：8

共 29 条

[1] Preoperative symptom evaluation and esophageal acid infusion predict response to laparoscopic Nissen fundoplication in gastroesophageal reflux patients who present with cough [J].