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首页> 外文期刊>Surgical Endoscopy >Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease.
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Long-term outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease.

机译：神经系统正常儿童胃食管反流疾病的腹腔镜Nissen，Toupet和Thal抗反流手术的长期结果。

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BACKGROUND: Nissen fundoplication is the most popular laparoscopic operation for the management of gastroesophageal reflux disease (GERD). Partial fundoplications seem to be associated with a lower incidence of postoperative dysphagia, and thus a better quality of life for patients. The aim of this study was to compare the long-term outcome in neurologically normal children who underwent laparoscopic Nissen, Toupet, or Thal procedures in three European centers with a large experience in laparoscopic antireflux procedures. METHODS: This study retrospectively analyzed the data of 300 consecutive patients with GERD who underwent laparoscopic surgery. The first 100 cases were recorded for each team, with the first team using the Toupet, the second team using the Thal, and the third team using the Nissen procedure. The only exclusion criteria for this study was neurologic impairment. For this reason, 66 neurologically impaired children (52 Thal, 10 Nissen, 4 Toupet) were excluded from the study. This evaluation focuses on the data for the remaining 238 neurologically normal children. The patients varied in age from 5 months to 16 years (median, 58 months). The median weight was 20 kg. All the children underwent a complete preoperative workup, and all had well-documented GERD. The position of the trocars and the dissection phase were similar in all the procedures, as was the posterior approximation of the crura. The short gastric vessels were divided in only six patients (2.5%). The only difference in the surgical procedures was the type of antireflux valve created. RESULTS: The median duration of surgery was 70 min. There was no mortality and no conversion in this series. A total of 12 (5%) intraoperative complications (5 Nissen, 5 Toupet, 2 Thal) and 13 (5.4%) postoperative complications (3 Toupet, 4 Nissen, 6 Thal) were recorded. Only six (2.5%) redo procedures (2 Thal, 2 Toupet, 2 Nissen) were performed. After a minimum follow-up period of 5 years, all the children were free of symptoms except nine (3.7%), who sometimes still require medication. The incidence of complications and redo surgery for the three procedures analyzed with the Mann-Whitney U test are not statistically significant. CONCLUSIONS: For pediatric patients with GERD, laparoscopic Nissen, Toupet, and Thal antireflux procedures yielded satisfactory results, and none of the approaches led to increased dysphagia. The 5% rate for intraoperative complications seems linked to the learning curve period. The authors consider the three procedures as extremely effective for the treatment of children with GERD, and they believe that the choice of one procedure over the other depends only on the surgeon's experience. Parental satisfaction with laparoscopic treatment was very high in all the three series.
机译：背景：尼森胃底折叠术是用于治疗胃食管反流病（GERD）的最流行的腹腔镜手术。部分胃底折叠术似乎与术后吞咽困难的发生率较低有关，因此患者的生活质量更高。这项研究的目的是比较三个欧洲中心接受腹腔镜Nissen，Toupet或Thal手术的神经学正常儿童的长期结果，这些儿童在腹腔镜抗反流手术方面经验丰富。方法：本研究回顾性分析了300例接受腹腔镜手术的GERD患者的数据。每队记录前100个案件，第一队使用Toupet，第二队使用Thal，第三队使用Nissen程序。这项研究的唯一排除标准是神经系统损害。因此，本研究排除了66名神经系统受损的儿童（52个塔尔，10个尼森，4个图皮特）。该评估的重点是其余238名神经系统正常儿童的数据。患者的年龄从5个月到16岁（中位数58个月）不等。中位重量为20公斤。所有的孩子都接受了完整的术前检查，并且所有人都有完整的GERD。在所有程序中，套管针的位置和解剖阶段都相似，后交叉逼近。胃短血管仅被分为6例（2.5％）。手术过程中的唯一区别是所创建的防回流阀的类型。结果：中位手术时间为70分钟。该系列没有死亡率，也没有转化。总共记录了12（5％）的术中并发症（5 Nissen，5 Toupet，2 Thal）和13（5.4％）的术后并发症（3 Toupet，4 Nissen，6 Thal）。仅执行了六次（2.5％）重做过程（2个Thal，2个Toupet，2个Nissen）。经过最少5年的随访后，所有儿童均无症状，只有九名儿童（3.7％）有时仍需要药物治疗。用Mann-Whitney U检验分析的三种方法的并发症和重做手术的发生率均无统计学意义。结论：对于患有GERD的小儿患者，腹腔镜Nissen，Toupet和Thal的抗返流手术效果令人满意，并且没有一种方法导致吞咽困难加剧。术中并发症的5％发生率似乎与学习曲线周期有关。作者认为这三种方法对GERD儿童的治疗极为有效，他们认为选择一种方法而不是另一种方法仅取决于外科医生的经验。在这三个系列中，父母对腹腔镜治疗的满意度都很高。

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