腹腔镜胃底折叠术后复发烧心症状与食管内酸反流的关系

Five-year efficacy of laparoscopic Nissen fundoplication versus anterior 180° partial fundoplication in the management of reflux esophagitis: A randomized controlled trial

AIM: To evaluate the long-term clinical outcome of laparoscopic Nissen fundoplication versus anterior 180° partial fundoplication in the management of reflux esophagitis.

METHODS: One hundred and seven patients with reflux esophagitis were enrolled and randomly allocated into two groups to undergo laparoscopic Nissen fundoplication (Nissen group) and laparoscopic anterior 180° partial fundoplication (partial fundoplication group). The patients were followed for 5 years after operation, and clinical data, such as the incidences of heartburn, dysphagia, bloating or flatulence, belching ability, and degree of satisfaction with the operation, were collected.

RESULTS: There were no statistical significances between the two groups for the incidence of heartburn symptom and consumption of PPI. Though the incidence of dysphagia was similar between the two groups, the severity of the symptom in the partial fundoplication group was much lower than that in the Nissen group. There is a higher incidence of epigastric bloating, difficulty of belching and flatulence in the Nissen group. The degree of overall satisfaction with the operation was similar between the two groups. Most patients were free of reflux symptoms during the 5-year follow-up period.

CONCLUSION: Laparoscopic anterior 180° partial fundoplication has good and durable anti-reflux effect and is associated with a lower incidence of post-operative complications compared to Nissen fundoplication, and can be employed as a routine procedure for treatment of gastroesophageal reflux disease.