Laparoscopic revision of failed fundoplication and hiatal herniorraphy.
Laparoscopic revision of failed fundoplication and hiatal herniorraphy.
复制标题
失败的胃底折叠术和食管裂孔疝修补术的腹腔镜翻修术。
DOI：
10.1089/lap.2008.0245
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发表时间：
2009
期刊：
影响因子：
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通讯作者：
Ayiomamitis,GeorgiosD
中科院分区：
文献类型：
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作者：
Frantzides,ConstantineT;Madan,AtulK;Carlson,MarkA;Zeni,TallalM;Zografakis,JohnG;Moore,RonaldM;Meiselman,Mick;Luu,Minh;Ayiomamitis,GeorgiosD
目的：本研究的目的是评估腹腔镜胃底折叠术失败的机制和结果的修订腹腔镜fundofolding.Background：腹腔镜Nissen胃底折叠术已成为最常用的抗反流程序治疗胃食管反流病，成功率从90至95%。持续的或新的症状往往需要内镜和放射学研究，以找到手术失败的原因。在经验丰富的手，再次手术抗反流手术可以做腹腔镜。方法：回顾性分析1992年至2006年腹腔镜组主要作者和研究员对失败的胃底折叠术行腹腔镜下翻修术的病例。结果：1992年至2006年对68例失败的胃底折叠术行腹腔镜下翻修术。腹腔镜再次Nissen胃底折叠术的成功率为86%。翻修手术前的症状包括烧心（69%）、吞咽困难（8.8%）或两者兼而有之（11.7%）。术前评估显示食管炎41%，食管裂孔疝伴食管炎36%，食管裂孔疝不伴食管炎7.3%，狭窄11.74%，运动障碍2.4%。主要的腹腔镜翻修术包括单纯胃底折叠术（41%）或胃底折叠术联合食管裂孔疝修补术（50%）。发生了4例胃穿孔;这些穿孔均进行了初步修复，未发生进一步事件。1例患者进行了开放性转换。住院时间为2.5 ± 1.0天。平均随访时间为22个月（范围，6-42），在此期间，失败的重做程序中注意到9例（13.23%）。结论：腹腔镜重做抗反流手术，在腹腔镜奖学金计划进行，产生良好的效果，方法的成功率的主要操作。
Objective:The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication.Background:Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure. In experienced hands, reoperative antireflux surgery can be done laparoscopically. We performed a retrospective analysis of all laparoscopic revision of failed fundoplications done by the principle author and the respective fellow within the laparoscopic fellowship from 1992 to 2006.Methods:A review was performed on patients who underwent laparoscopic revision of a failed primary laparoscopic fundoplication.Results:Laparoscopic revision of failed fundoplication was performed on 68 patients between 1992 and 2006. The success rate of the laparoscopic redo Nissen fundoplication was 86%. Symptoms prior to the revision procedure included heartburn (69%), dysphagia (8.8%), or both (11.7%). Preoperative evaluation revealed esophagitis in 41%, hiatal hernia with esophagitis in 36%, hiatal hernia without esophagitis in 7.3%, stenosis in 11.74%, and dysmotility in 2.4%. The main laparoscopic revisions included fundoplication alone (41%) or fundoplication with hiatal hernia repair (50%). Four gastric perforations occurred; these were repaired primarily without further incident. An open conversion was performed in 1 patient. Length of stay was 2.5 ± 1.0 days. Mean follow-up was 22 months (range, 6–42), during which failure of the redo procedure was noted in 9 patients (13.23%).Conclusion:Laparoscopic redo antireflux surgery, performed in a laparoscopic fellowship program, produces excellent results that approach the success rates of primary operations.