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首页> 外文期刊>Surgical Endoscopy >Revision of failed traditional fundoplication using EsophyX transoral fundoplication.
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Revision of failed traditional fundoplication using EsophyX transoral fundoplication.

机译：使用EsophyX经口胃底折叠术对失败的传统胃底折叠术进行修订。

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Laparoscopic revision of failed traditional fundoplication is difficult and involves risk of gastric, esophageal, and vagal nerve injury that is higher than that of the primary fundoplication. This study assessed feasibility and clinical outcomes of the transoral approach to revision of loose Nissen.Between November 2009 and August 2011, a total of 11 patients underwent transoral repair as opposed to 70 patients who underwent laparoscopic or open revision of a failed fundoplication. Subjective and objective outcomes were evaluated with the GERD health-related quality of life (GERD-HRQL) questionnaire and the reflux symptom index (RSI) questionnaire and ambulatory pH testing. The competency of the new antireflux barrier was evaluated by endoscopy. Wilcoxon signed-rank test was used to compare pre- and postoperative variables.All 11 patients evidenced loosening of the Nissen fundoplication without evidence of hiatal failure. Mean age was 57 years, BMI was 25.1 kg/m(2), and 4 of 11 (36 %) were female. Indications for operation were abnormal pH-metry off PPIs (6), impedance/pH on PPIs (3), esophagitis (1), and evidence of free reflux on barium swallow (1). One patient developed a postoperative bleed requiring transfusion. Two patients had laparoscopic revision at 6 and 8 months after the transoral procedure. At a median follow-up of 14 (range = 6-28) months, 8/10 patients reported resolution of their primary symptoms. Eight patients had pH testing off PPIs both pre- and postoperatively; median % time with pH <4 improved by dropping from 8.1 % (21-4.8 %) to 0.6 % (13.4-0.01 %) (p = 0.008). Esophageal acid exposure normalized in 5/6 patients. Mean GERD-HRQL score improved significantly by dropping from 28.6 (10.6) preoperatively to 6.7 (6.1) post-TIF (p = 0.016). Mean RSI score improved more than 50 % in 5/7 patients.Transoral revision of failed traditional fundoplication without herniation is technically feasible. It results in symptomatic and objective improvement of GERD without the risks of laparoscopic dissection for a majority of patients.
机译：失败的传统胃底折叠术的腹腔镜翻修是困难的，并且涉及胃，食道和迷走神经损伤的风险高于原发性胃底折叠术。这项研究评估了经口行松散Nissen翻修术的可行性和临床结果.2009年11月至2011年8月，共有11例患者接受了经口修复，而70例接受了腹腔镜或开放翻修失败的胃底折叠术。使用GERD健康相关生活质量（GERD-HRQL）问卷，反流症状指数（RSI）问卷和动态pH测试评估主观和客观结果。通过内窥镜评估新的抗反流屏障的能力。 Wilcoxon符号秩检验用于比较术前和术后变量。所有11例患者均表现出Nissen胃底折叠松动，而无裂孔性衰竭的证据。平均年龄为57岁，BMI为25.1 kg / m（2），11名女性中有4名（36％）。手术指征为PPI的pH值测量异常（6），PPI的阻抗/ pH值（3），食管炎（1）和钡剂自由反流的证据（1）。一名患者发生术后出血，需要输血。两名患者在经口手术后6和8个月进行了腹腔镜翻修。在中位随访14（范围= 6-28）个月时，有8/10名患者报告其主要症状已缓解。八例患者在术前和术后均接受过PPI的pH测试。 pH值<4的中位时间百分比从8.1％（21-4.8％）降低至0.6％（13.4-0.01％）（p = 0.008）。食管酸暴露在5/6患者中恢复正常。术前平均GERD-HRQL评分从术前的28.6（10.6）降低至TIF后的6.7（6.1）（p = 0.016）。在5/7的患者中，平均RSI评分提高了50％以上。传统的胃底折叠术失败而无疝的经皮修订在技术上是可行的。对于大多数患者来说，它可改善GERD的症状和客观症状，而无腹腔镜解剖的风险。

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