Short-term efficacy of laparoscopic Nissen fundoplication combined with the reconstruction of His angle in the treatment of gastroesophageal reflux disease

doi:10.3877/cma.j.issn.1674-392X.2022.05.005

Abstract

Abstract:

Objective

To investigate the efficacy of Nissen fundoplication combined with the reconstruction of His angle for gastroesophageal reflux disease (GERD).

Methods

The clinical data of GERD patients who received Nissen fundoplication combined with His angle reconstruction or Nissen fundoplication alone in the department of general surgery of Xuanwu Hospital of Capital Medical University from October 2018 to February 2021 were retrospectively analyzed. The differences of the anti-reflux effects and the satisfaction of the two procedures were observed and compared.

Results

98 GERD patients were included in this study, including 52 patients in the Nissen+His angle reconstruction group and 46 patients in the Nissen group. 6 months after operation, GERD related symptoms (esophageal symptoms: reflux, heart burn, chest and back pain, and distension in the lower of xiphoid; extraesophageal symptoms: cough, wheezing, foreign body sensation of pharynx) scores were significantly lower than those before treatment (all P<0.05). In postoperative symptoms scores, score of the reflux and heart burn symptom of the Nissen+His angle reconstruction group were lower than that of Nissen group, the difference was statistically significant (reflux: Z=-2.466, P=0.014; heart burn: Z=-2.674, P=0.007). There was no statistical difference in the scores of other symptom between the two groups (all P>0.05). Postoperative functional complications (including dysphagia, abdominal distention, difficult belching, increased exhaust and chronic abdominal pain) were similar in both groups, and were significantly relieved after conservative treatment. The satisfaction of the group of Nissen+His angle reconstruction and the group of Nissen was 94.2% (49/52) and 91.3% (42/46), respectively, and no significant difference was observed (P=0.866).

Conclusion

Both Nissen+His angle reconstruction and Nissen fundoplication alone had good anti-reflux efficacy, with few and mild surgical complications and high patient satisfaction. Compared to Nissen group, Nissen+His angle reconstruction group had better control of reflux and heart burn symptoms, which required prospective, large-sample, and long-term follow-up results to confirm.

Key words: Gastroesophageal reflux disease, Fundoplication, Laparoscopes

Xing Du, Ying Luo, Ying Gao, Qingshen Dong, Diangang Liu, Zhonggao Wang, Yulin Zheng. Short-term efficacy of laparoscopic Nissen fundoplication combined with the reconstruction of His angle in the treatment of gastroesophageal reflux disease[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(05): 510-515.

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Figures/Tables 5

References 28

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组别	例数	性别[例(%)]		年龄(岁, ±s)	体质量指数(kg/m², ±s)	反流性食管炎[例(%)]	24h MII-pH监测M(P25,P75)				HRM M(P25,P75)
组别	例数	男	女	年龄(岁, ±s)	体质量指数(kg/m², ±s)	反流性食管炎[例(%)]	Demeester积分	AET(%)	BET(%)	反流总次数	LES(mmHg)		UES(mmHg)
Nissen+His角重建组	52	21(40.4)	31(59.6)	52.37±16.88	24.7±5.4	37(71.1)	25.3(14.6,38.9)	9.7(5.1,2.8)	2.4(1.0,4.3)	79(55.1,84)	6.9(3.4,11.9)		47.1(27.1,72.5)
Nissen组	46	19(41.3)	27(58.7)	54.35±14.06	26.7±4.3	28(60.9)	23.3(14.1,37.7)	8.2(3.6,1.0)	2.2(0.8,3.2)	74(52.8,77.3)	7.8(5.2,11.7)		48.3(27.5,73.1)
P		0.926		0.532	0.413	0.282	0.253	0.287	0.054	0.234	0.265	0.576

组别	例数	性别[例(%)]		年龄(岁, ±s)	体质量指数(kg/m², ±s)	反流性食管炎[例(%)]	24h MII-pH监测M(P25,P75)				HRM M(P25,P75)
组别	例数	男	女	年龄(岁, ±s)	体质量指数(kg/m², ±s)	反流性食管炎[例(%)]	Demeester积分	AET(%)	BET(%)	反流总次数	LES(mmHg)		UES(mmHg)
Nissen+His角重建组	52	21(40.4)	31(59.6)	52.37±16.88	24.7±5.4	37(71.1)	25.3(14.6,38.9)	9.7(5.1,2.8)	2.4(1.0,4.3)	79(55.1,84)	6.9(3.4,11.9)		47.1(27.1,72.5)
Nissen组	46	19(41.3)	27(58.7)	54.35±14.06	26.7±4.3	28(60.9)	23.3(14.1,37.7)	8.2(3.6,1.0)	2.2(0.8,3.2)	74(52.8,77.3)	7.8(5.2,11.7)		48.3(27.5,73.1)
P		0.926		0.532	0.413	0.282	0.253	0.287	0.054	0.234	0.265	0.576

组别	例数	食管症状				食管外症状
组别	例数	反流	胃灼热	胃灼热	剑突下顶胀感	咳嗽	喘息	咽部异物感
Nissen+His角重建组	52	7(6,8)	7(5,8)	4(0,6)	3(0,6)	2(0,5)	4(0,5)	4.5(0,6)
Nissen组	46	7(5,7)	7(5,8)	1(0,5)	0(0,5)	2(0,4.3)	3(0,5)	3(0,5)
Z		-1.151	-0.134	-1.334	-1.637	-0.615	-0.853	-1.115
P		0.25	0.894	0.182	0.102	0.539	0.394	0.265

组别	例数	食管症状				食管外症状
组别	例数	反流	胃灼热	胃灼热	剑突下顶胀感	咳嗽	喘息	咽部异物感
Nissen+His角重建组	52	7(6,8)	7(5,8)	4(0,6)	3(0,6)	2(0,5)	4(0,5)	4.5(0,6)
Nissen组	46	7(5,7)	7(5,8)	1(0,5)	0(0,5)	2(0,4.3)	3(0,5)	3(0,5)
Z		-1.151	-0.134	-1.334	-1.637	-0.615	-0.853	-1.115
P		0.25	0.894	0.182	0.102	0.539	0.394	0.265

组别			术前	术后	Z	P
Nissen+His角重建组
	食管症状
		反流	7(6,8)	0(0,2)	-6.317	<0.001
		胃灼热	7(5,8)	0(0,2)	-6.244	<0.001
		胸背痛	4(0,6)	0(0,2)	-4.989	<0.001
		剑突下顶胀感	3(0,6)	0(0,1.5)	-4.802	<0.001
	食管外症状
		咳嗽	2(0,5)	0(0,2)	-4.672	<0.001
		喘息	4(0,5)	0(0,2)	-4.920	<0.001
		咽部异物感	4.5(0,6)	0(0,2)	-5.131	<0.001
Nissen组
	食管症状
		反流	7(5,7)	2(0,3)	-5.813	<0.001
		胃灼热	7(5,8)	2(0,2)	-5.866	<0.001
		胸背痛	1(0,5)	0(0,0)	-4.220	<0.001
		剑突下顶胀感	0(0,5)	0(0,0)	-4.031	<0.001
	食管外症状
		咳嗽	2(0,4.3)	0(0,2)	-4.223	<0.001
		喘息	3(0,5)	0(0,2)	-4.405	<0.001
		咽部异物感	5(3,6)	2(0,2.3)	-5.363	<0.001

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