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首页> 外文期刊>Surgical Endoscopy >Dysphagia after laparoscopic antireflux surgery: a problem of hiatal closure more than a problem of the wrap.
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Dysphagia after laparoscopic antireflux surgery: a problem of hiatal closure more than a problem of the wrap.

机译：腹腔镜抗反流手术后吞咽困难：裂孔闭合的问题比包裹的问题更多。

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BACKGROUND: Postoperative dysphagia after laparoscopic antireflux surgery usually is transient and resolves within weeks after surgery. Persistent dysphagia develops in a small percentage of patients after surgery. There still is debate about whether postoperative dysphagia is caused by the type or placement of the fundic wrap or by mechanical obstruction of the hiatal crura. This study aimed to investigate patients who experienced recurrent or persistent dysphagia after laparoscopic antireflux surgery, and to identify the morphologic reason for this complication. METHODS: A sample of 50 patients consecutively referred to the authors' unit with recurrent, persistent, or new-onset of dysphagia after laparoscopic antireflux surgery were prospectively reviewed to identify the morphologic cause of postoperative dysphagia. According to their radiologic findings, these patients were divided into three groups: patients with signs of obstruction at or above the gastroesophageal junction suspicious of crural stenosis (group A; n = 18), patients with signs of total or partial migration of the wrap intrathoracically (group B; n = 27), and patients in whom the hiatal closure was radiologically assessed to be correct with a supposed stenosis of the wrap (group C; n = 5). The exact diagnosis of a too tight (group A) or too loose (group B) hiatus in contrast to a too tight wrap (group C) was established during laparoscopic redo surgery (groups B and C) or by x-ray during pneumatic dilation (group A). RESULTS: For all 18 group A patients, intraoperative x-ray during pneumatic dilation showed the typical signs of hiatal tightness. Of these, 15 were free of symptoms after dilation, and 3 had to undergo laparoscopic redo surgery because of persistent dysphagia. In all these patients, the hiatal closure was narrowing the esophagus. All the group B patients underwent laparoscopic redo surgery because of intrathoracic wrap migration. Intraoperatively, all the patients had an intact fundoplication, which slipped above the diaphragm. Definitely, only in 10% of all 50 patients (group C) presenting with the symptom of dysphagia, was the morphologic reason for the obstruction a problem of the fundic wrap. CONCLUSIONS: In most patients, postoperative dysphagia is more a problem of hiatal closure than a problem of the fundic wrap.
机译：背景：腹腔镜抗反流手术后的吞咽困难通常是暂时性的，并且在术后数周内可缓解。手术后一小部分患者会出现持续性吞咽困难。关于术后吞咽困难是否是由胃底包裹物的类型或位置引起的还是由食管裂口的机械性阻塞引起的，仍存在争议。这项研究旨在调查在腹腔镜抗反流手术后经历反复或持续性吞咽困难的患者，并查明这种并发症的形态学原因。方法：前瞻性地回顾性分析了50例连续转诊至作者所在单位的腹腔镜抗反流手术后出现反复，持续或新发的吞咽困难的患者，以确定术后吞咽困难的形态学原因。根据他们的放射学发现，将这些患者分为三组：在胃食管连接处或上方有可疑的狭窄狭窄的体征（A组; n = 18），在胸腔内全部或部分迁移的体征的患者（B组; n = 27），以及经放射学评估裂孔闭合的正确性与假想狭窄的患者（C组; n = 5）。与腹膜镜重做手术（B组和C组）或气管扩张时通过X线检查相比，确诊为太紧（A组）或太松（B组）裂孔而不是包扎太紧（C组） （A组）。结果：对于所有18名A组患者，术中X线检查显示的是气管扩张的典型征象。其中有15例在扩张后无症状，还有3例由于持续性吞咽困难而不得不进行腹腔镜重做手术。在所有这些患者中，食管裂孔使食管狭窄。由于胸膜包裹物的迁移，所有B组患者都进行了腹腔镜重做手术。术中，所有患者均发生完整的胃底折叠术，其滑到above肌上方。毫无疑问，在所有出现吞咽困难症状的50例患者（C组）中，只有10％的患者的形态学原因是眼底包裹物阻塞。结论：在大多数患者中，术后吞咽困难更多的是食管裂孔而不是胃底包裹的问题。

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