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首页> 外文期刊>Surgical Endoscopy >Best reoperative strategy for failed fundoplication: redo fundoplication or conversion to Roux-en-Y gastric diversion?
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Best reoperative strategy for failed fundoplication: redo fundoplication or conversion to Roux-en-Y gastric diversion?

机译：失败的FoodProplication的最佳重复策略：重做Foodoplication或转换为Roux-en-Y胃源转移？

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摘要

Background Failed fundoplication is a difficult reoperative challenge, with limited evidence differentiating outcomes of a redo fundoplication versus conversion to Roux-en-Y anatomy with a gastric diversion (RYGD). The aim of this study was to determine the impact of these reoperative strategies on symptom resolution. Methods A retrospective single institution study of patients with failed fundoplications undergoing conversion to RYGD or redo fundoplication between 2006 and 2019 was conducted. Patient characteristics, preoperative evaluation, operative findings, and postoperative outcomes were recorded and analyzed. Results 180 patients with symptomatic, failed fundoplications were identified: 101 patients (56.1%) underwent conversion to RYGD, and 79 patients (43.9%) underwent redo fundoplication. Body mass index (BMI) was significantly higher for the patients undergoing RYGD with mean BMI of 34.3 +/- 6.9 vs 27.7 +/- 3.9 kg/m(2)(p < 0.001). Patients undergoing conversion to RYGD were also more comorbid than their counterparts, with higher rates of obstructive sleep apnea (17.8% vs 5.1%,p = 0.01), but similar rates of hypertension (54.5% vs 44.3%,p = 0.18, asthma/COPD (25.7% vs 16.5%,p = 0.13), diabetes (10.9% vs 10.1%,p = 0.87), and hyperlipidemia (29.7% vs 36.7%,p = 0.32). Mean operative times were significantly higher for the RYGD (359.6 +/- 90.4 vs 238.8 +/- 75.6 min,p < 0.0001), as was mean estimated blood loss (168.8 +/- 207.5 vs 81.0 +/- 145.4,p < 0.0001). Conversion rates from minimally invasive to open were similar (10.9% vs 11.4%,p = 0.92). The incidence of recurrent reflux symptoms was not significantly different (p = 0.46) between RYGD (16.8%) and redo fundoplication (12.8%), at an average follow-up of 50.6 +/- 140.7 vs 34.7 +/- 39.2 months, (p = 0.03). For the RYGD cohort, patients also had resolution of other comorbidities including obesity 35.6%, OSA 16.7%, hyperlipidemia 10.0%, hypertension 9.1%, and diabetes 9.1%. On average, patients decreased their BMI by 6.8 +/- 5.5 kg/m(2)and lost 69.6% of their excess body weight. Mean length of stay was higher in patients undergoing RYGD (5.3 +/- 7.3 vs 3.0 +/- 1.9 days,p = 0.01). Thirty-day readmission rates were similar (9.9% vs 3.8%,p = 0.12). The reoperation rate was higher in the RYGD cohort (17.8% vs 2.5%,p = 0.001). Conclusions RYBG and redo fundoplication are equivalent in terms of resolution of reflux. RYGD resulted in significant loss of excess body weight.
机译：背景：失败的胃底折叠术是一个困难的再手术挑战，仅有有限的证据区分重做胃底折叠术和胃转流术（RYGD）后转为Roux-en-Y解剖术的结果。本研究的目的是确定这些再手术策略对症状缓解的影响。方法对2006年至2019年间接受RYGD或重做胃底折叠术的失败胃底折叠术患者进行回顾性单机构研究。记录并分析患者特征、术前评估、手术结果和术后结果。结果180例有症状、失败的胃底折叠术患者被确诊：101例（56.1%）患者转为RYGD，79例（43.9%）患者再次行胃底折叠术。接受RYGD治疗的患者的体重指数（BMI）显著高于接受RYGD治疗的患者，平均BMI为34.3+/-6.9 vs 27.7+/-3.9 kg/m2（p<0.001）。转换为RYGD的患者也比他们的同龄人有更多的共病，阻塞性睡眠呼吸暂停的发生率更高（17.8%比5.1%，p=0.01），但高血压的发生率相似（54.5%比44.3%，p=0.18，哮喘/COPD（25.7%比16.5%，p=0.13），糖尿病（10.9%比10.1%，p=0.87），高脂血症（29.7%比36.7%，p=0.32）。RYGD的平均手术时间（359.6+/-90.4 vs 238.8+/-75.6 min，p<0.0001）和平均估计失血量（168.8+/-207.5 vs 81.0+/-145.4，p<0.0001）显著增加。从微创到开放的转化率相似（10.9%对11.4%，p=0.92）。在平均随访50.6+/-140.7个月和34.7+/-39.2个月的情况下，RYGD（16.8%）和redo胃底折叠术（12.8%）之间复发性反流症状的发生率没有显著差异（p=0.46）（p=0.03）。在RYGD队列中，患者的其他共病也得到了缓解，包括肥胖35.6%、OSA 16.7%、高脂血症10.0%、高血压9.1%和糖尿病9.1%。平均而言，患者的BMI降低了6.8+/-5.5 kg/m（2），体重减轻了69.6%。RYGD患者的平均住院时间更长（5.3+/-7.3天vs 3.0+/-1.9天，p=0.01）。30天再入院率相似（9.9%对3.8%，p=0.12）。RYGD队列的再次手术率较高（17.8%对2.5%，p=0.001）。结论RYBG和redo胃底折叠术在解决反流方面是等效的。RYGD导致超重体重显著减轻。

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  • 来源
    《Surgical Endoscopy》 |2021年第7期|共9页
  • 作者

    Shao Jenny M.; Elhage Sharbel A.; Prasad Tanu; Gersin Keith; Augenstein Vedra A.; Colavita Paul D.; Heniford B. Todd;

  • 作者单位

    Carolinas Med Ctr Dept Surg Gastrointestinal &

    Minimally Invas Surg 1025 Morehead Med Dr Suite;

    Carolinas Med Ctr Dept Surg Gastrointestinal &

    Minimally Invas Surg 1025 Morehead Med Dr Suite;

    Carolinas Med Ctr Dept Surg Gastrointestinal &

    Minimally Invas Surg 1025 Morehead Med Dr Suite;

    Carolinas Med Ctr Dept Surg Atrium Hlth Weight Management Charlotte NC 28204 USA;

    Carolinas Med Ctr Dept Surg Gastrointestinal &

    Minimally Invas Surg 1025 Morehead Med Dr Suite;

    Carolinas Med Ctr Dept Surg Gastrointestinal &

    Minimally Invas Surg 1025 Morehead Med Dr Suite;

    Carolinas Med Ctr Dept Surg Gastrointestinal &

    Minimally Invas Surg 1025 Morehead Med Dr Suite;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 诊断学;
  • 关键词

    Reoperative fundoplication; Roux-en-Y gastric diversion; Reflux;

    机译：再手术性胃底折叠术;Roux-en-Y胃分流术;回流;

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