A Retrospective Analysis Of Three Laparoscopic Fundopljcation For The Treatment Of Severe Gastro-esophageal Refulx Disease

Objective:Gastroesophageal reflux disease (GERD) is a kind of promoted by many factors of upper gastrointestinal motility disorders, generally to proceed with the reflux of gastric contents into the esophagus, with a series of symptoms and complications caused by esophageal. Research suggests that the typical clinical manifestations of GERD for acid reflux, heartburn, and some atypical symptoms, such as asthma, laryngeal spasm, hearing loss, chronic cough, pharyngeal foreign body sensation and hoarseness. In recent years, the relationship between GERD and cardiovascular and respiratory system diseases has attracted the attention of doctors, all over the country have established gastroesophageal reflux disease diagnosis and treatment center. Drug treatment is still the main method in the treatment of GERD, but requires long-term medication and difficult to maintain curative effect, and all kinds of endoscopic treatment method is less traumatic, but the long-term effect is not clear. Since the treatment method of introducing modern laparoscopy, surgical treatment of GERD has undergone tremendous change, open operation caused discomfort, huge tissue trauma and risk has been replaced by minimally invasive laparoscopic operation technology. Laparoscopic fundoplication (LF) due to trauma, slight pain, fast recovery advantages, less postoperative complications, shorter hospitalization time etc, has been widely used in the surgical treatment of GERD, but the long-term efficacy still need case observation and long-term follow-up study large-scale. Controlled trial in patients with our2001June-2010plication on January in Tianjin Nankai hospital received laparoscopic fundoplication severe GEAD in line with the conditions of a total of248patients were retrospectively reviewed the treatment effect, evaluation of three laparoscopic fundoplication for gastroesophageal reflux disease (GERD) of the ant reflux effect of operation treatment.Methods:a retrospective analysis of from2005June to2010January a total of248cases of laparoscopic fundoplication for GERD clinical data. Laparoscopic Nissen fundoplication in134cases, laparoscopic Dor fundoplication (180°) operation in74cases,40cases of Toupet operation.3groups all carried out before and after operation, endoscopy, esophageal motility and24h esophageal pH monitoring, and a reflux disease questionnaire (RDQ) survey. Comparison of the three groups during the operation period, the rate of adverse reactions, complications and recurrence rate in patients with no efficiency.Results:the patients were followed up for6to103months, average36.9months, three patients were improved and the lower esophageal sphincter function, RDQ, lower esophageal peristalsis pressure and24h esophageal pH monitoring parameters, after operation in the three groups according to RDQ score after6months of heartburn, reflux, non cardiac chest pain, acid reflux scores were significantly decreased, RDQ score to Nissen operation to improve the most significant:Nissen group significantly improved from preoperative22.7±4.3to3.3±1.12after operation; group Dor from preoperative19.6±5.2to8.4±1.6after operation; group Toupet from preoperative20.1±5.3to7.7±1.3(P<0.05), a significant difference between the Nissen group and the other group of two two (t1=2.71, t2=2.89, P<0.05). Preoperative endoscopy confirmed GEAD positive were114,62,35cases, postoperative recovery, converted into0levels:79,34,22,21,11cases improved,4cases, effective rate was87.7%,72.6%,72.3%. There was no significant difference between the patients’ satisfaction and the rest of the observed indexes, Nissen surround operation period complications, adverse reactions, Toupet is more common than Dor. Dor easier than Nissen, Toupet, high rate of recurrence is invalid.Conclusion:the three kinds of laparoscopic fundoplication can effectively reduce gastroesophageal reflux, but the need of careful selection of good, in order to tailor specific characteristics of each patient carefully selected. The preoperative evaluation of patients with esophageal and lower esophageal sphincter function, esophageal motor function, for mild to moderate GEAD can choose Dor, for severe GEAD can choose to Nissen, by selecting different operations to ensure the long-term effective ant reflux effect.