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首页> 外文期刊>Surgical Endoscopy >Causes of dissatisfaction after laparoscopic fundoplication: The impact of new symptoms, recurrent symptoms, and the patient experience
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Causes of dissatisfaction after laparoscopic fundoplication: The impact of new symptoms, recurrent symptoms, and the patient experience

机译：腹腔镜胃底折叠术后不满意的原因：新症状，复发症状和患者体验的影响

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Background: Although laparoscopic fundoplication effectively alleviates gastroesophageal reflux disease (GERD) in the great majority of patients, some patients remain dissatisfied after the operation. This study was undertaken to report the outcomes of these patients and to determine the causes of dissatisfaction after laparoscopic fundoplication. Methods: All patients undergoing laparoscopic fundoplication in the authors' series from 1992 to 2010 were evaluated for frequency and severity of symptoms before and after laparoscopic fundoplication, and their experiences were graded from "very satisfying" to "very unsatisfying." Objective outcomes were determined by endoscopy, barium swallow, and pH monitoring. Primary complaints were derived from postoperative surveys. Median data are reported. Results: Of the 1,063 patients undergoing laparoscopic fundoplication, 101 patients reported dissatisfaction after the procedure. The follow-up period was 33 months. The dissatisfied patients (n = 101) were more likely than the satisfied patients to have postoperative complications (9 vs 4 %; p < 0.05) and to have undergone a prior fundoplication (22 vs 11 %; p < 0.05). For the dissatisfied patients, heartburn decreased in frequency and severity after fundoplication (p < 0.05) but remained notable. Also for the dissatisfied patients, new symptoms (gas bloat/dysphagia) were the most prominent postoperative complaint (59 %), followed by symptom recurrence (23 %), symptom persistence (4 %), and the overall experience (14 %). Primary complaints of new symptoms were most common within the first year of follow-up assessment and less frequent thereafter. Primary complaints of recurrent symptoms generally occurred more than 1 year after fundoplication. Conclusions: Dissatisfaction is uncommon after laparoscopic fundoplication. New symptoms, such as dysphagia and gas/bloating, are primary causes of dissatisfaction despite general reflux alleviation among these patients. New symptoms occur sooner after fundoplication than recurrent symptoms and may become less common with time.
机译：背景：尽管腹腔镜胃底折叠术可有效缓解绝大多数患者的胃食管反流病（GERD），但仍有部分患者术后不满意。进行这项研究是为了报告这些患者的结局，并确定腹腔镜胃底折叠术后不满意的原因。方法：对作者于1992年至2010年进行的所有腹腔镜胃底折叠术患者的腹腔镜胃底折叠术前后的症状发生频率和严重程度进行评估，并将他们的经历从“非常满意”分为“非常不满意”。客观结果通过内窥镜检查，钡餐和pH监测确定。主要的抱怨来自术后调查。报告中位数数据。结果：在接受腹腔镜胃底折叠术的1,063例患者中，有101例在手术后表示不满意。随访时间为33个月。不满意的患者（n = 101）比满意的患者更有可能发生术后并发症（9 vs 4％; p <0.05），并且曾接受过胃底折叠术（22 vs 11％; p <0.05）。对于不满意的患者，胃底折叠术后胃灼热的频率和严重程度降低（p <0.05），但仍很明显。同样对于不满意的患者，新症状（气胀/吞咽困难）是术后最主要的主诉（59％），其次是症状复发（23％），症状持续（4％）和总体经历（14％）。新症状的主诉在随访评估的第一年内最为普遍，此后则较少。复发症状的主诉通常发生在胃底折叠术后1年以上。结论：腹腔镜胃底折叠术不满意的情况很少见。尽管这些患者普遍缓解了反流，但吞咽困难和气体/腹胀等新症状仍是患者不满意的主要原因。胃底折叠术后新症状比复发症状更早出现，并且随着时间的推移可能变得不那么常见。

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