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首页> 外文期刊>Surgical Endoscopy >Roux-en-Y reconstruction is superior to redo fundoplication in a subset of patients with failed antireflux surgery.
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Roux-en-Y reconstruction is superior to redo fundoplication in a subset of patients with failed antireflux surgery.

机译：Roux-Zh-Y重建优于重做Danteflux手术的患者的子集中的重做基础。

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A subset of patients requires reoperative antireflux surgery (Re-ARS) after failed fundoplication. The aim of this study was to determine symptomatic outcomes beyond 1 year following Re-ARS and to assess the relative utility of two different surgical approaches.After Institutional Review Board approval, patients who underwent Re-ARS were identified from a prospective database. Symptom severity was graded on a 0-3 scale. Patients with postoperative symptoms of grade ≥ 2 were considered to have a poor outcome. Patient satisfaction was graded using a 10-point visual analog scale.At least 1 year of follow-up was available for 130 patients. There were 94 redo fundoplications (RF) and 36 Roux-en-Y reconstructions (RNYR). Symptom risk factors (significant preoperative dysphagia, significant preoperative heartburn, esophageal dysmotility, short esophagus, delayed gastric emptying, multiple failed hiatal surgeries, reflux-related respiratory symptoms) were more prevalent in patients who underwent RNYR compared to RF (mean 3.0 vs. 2.2; p = 0.003). Postoperative leaks and major complications occurred in 4.5 % (5/110) versus 0% and 21.6 % versus 33.3 % of the RF and RNYR groups, respectively. Twenty-eight RF patients (29.8 %) and 9 RNYR patients (25.0 %) reported poor outcomes. Among patients with ≥ 4 risk factors, those who underwent RNYR had a lower incidence of poor outcome (7.7 % vs. 55 %, p = 0.018) and higher satisfaction scores (8.4 vs. 5.8, p = 0.001) compared to those who had RF. Overall, 85 % of patients were satisfied or highly satisfied with their results and the average satisfaction score was 8.2.Re-ARS provides good subjective outcomes when measured more than 1 year after surgery. Patients with more complex pathology benefit more from RNYR despite the higher postoperative complication rate. This is especially true for patients with decreased esophageal motility and short esophagus.
机译：患者的子集在失败的基础策略后需要重复的抗反射手术（RE-ARS）。本研究的目的是确定重新ars后1年之后的对症结果，并评估两种不同的手术方法的相对效用。制度审查委员会批准后，从预期数据库中确定了接受重新训练的患者。症状严重程度在0-3规模上进行分级。患有阶级≥2级症状的患者被认为具有较差的结果。患者满意度使用10分视觉模拟量表进行分级。可用于130名患者的至少1年后续随访。有94个重做基金会（RF）和36个ROUX-ZH-Y重建（RNYR）。症状风险因素（显着术前吞咽困难，显着的术前胃灼热，食管疑难虑，短食管，延迟胃排空，多重失败的胃肠杆菌，反流相关的呼吸症症状）在接受RNYR的患者中更为普遍（平均3.0与2.2 ; p = 0.003）。术后泄漏和主要并发症分别发生在4.5％（5/110）与0％和21.6％，分别为RF和RNYR组的33.3％。二十八名射频患者（29.8％）和9名RNYR患者（25.0％）报告了差的结果。 ≥4危险因素的患者中，与那些有关的人（7.7％，P = 0.018）和较高的满意度（8.4与5.8，p = 0.001），那些接受了RNYR的患者的发病率较低（7.7％。 rf。总体而言，85％的患者对其结果满意或高度满意，平均满意度得分为8.2.Re-AR在手术后1年以上的时间提供了良好的主观结果。尽管术后并发症率较高，但患有更复杂的病理学的患者更多地受益于RNYR。对食管运动和短食管减少的患者尤其如此。

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