Study On Laparoscopic Operations In The Treatment Of Gastro-esophageal Reflux Disease And Application Of Chinese Herbs In Postoperative Complications

ObjectiveCompare the postoperative outcomes and the incidence of complications among thepatients of laparoscopic Nissen fundoplication, Toupet fundoplication, anterior 180°fundoplication and dnterior 90°fundoplication. To determine the best surgical treatmentfor gastro-esophageal reflux disease. To observe Chinese Herbs' treatment forpost-operative complications.We sought to determine whether there is a relationship between postoperative symptomsand parameters measured by esophageal manometry, to determine whether earlypostoperative esophageal manometry is a useful investigation for the routine assessmentof post-fundoplication outcome.To determine whether dividing the shol-t gastric blood vessels during laparoscopic Nissenfundoplication could contribute to better postoperative outcomes.MethodsReview and analysis the postoperative outcomes and follow-up information of total andpartial fundoplication. Classify the patients with postoperative complications intodifferent types and treat them by using proper Chinese Herbs.143 patients who had undergone a laparoscopic Nissen fundoplication, clinical follow-upat 3 months and 5 years after surgery, and esophageal manometry at 3 months afterfundoplication as partof routine follow-up in one of 5 clinical trials, were studied.Nineteen o.fthese patients also underwent manometry 5 years after fundoplication.Postoperative symptoms were prospectively determined by applying a standardizedquestionnaire, which assessed dysphagia, heartburn, bloat symptoms, and overall satisfaction using analog scales. Patients were classified into different groups, accordingto the analog scores for clinical symptoms. Correlations between clinical andpostoperative manometry outcomes were sought.102 patients with gastro-esophageal reflux disease who underwent a laparoscopic Nissenfundoplication were entered into this randomized trial (vessels divided in 50, not dividedin 52). At 10-years follow-up, 88 patients provided clinical follow-up information.Follow-up was obtained by telephone interview and standardized questionnaires.ResultsIn our medical center, 62 cases were laparoscopic Toupet fundoplication and 87 werelaparoscopic Nissen fundoplication. The incidence of postoperative gas bloat anddysphagia in Toupet fundoplication was significantly lower than that in Nissenfundoplication (p=0.02,p=0.04). The analogue score ofdysphagia liquid and solid wasalso lower than that of Nissen fundoplication (p=0.03). More patients of Toupetfundoplication thought the operative outcomes were "excellent" (p=0.02) and had madethe "right decision" (p=0.048). Two types of operation could control reflux effectively.After taking Chinese Herbs for two weeks, gas bloat and dysphagia were significantlyalleviated, and dysphagia score for solid and liquid decreased dramatically as well.In Flinders Medical Center, 40cases were laparoscopic anterior 90~ fundoplication and39 were laparoscopic Nissen fundoplication. At l-year follow-up, the incidence of reflux,nausea, dysphagia and gas bloat in the patients who underwent laparoscopic anterior90°fundoplication was lower. There was no significant difference in the symptomsscore and-operative satisfaction between two groups.In Hinders Medical Center, 54cases were laparoscopic anterior 180°fundoplication and53 were laparoscopic Nissen fundoplication. Two types of operation both could controlreflux effectively. Laparoscopic anterior 180°fundoplication could contribute to lower incidence of dysphagia and gas bloat, and better postoperative outcomes, such as lowerdysphagia score for solid(0.6 vs 1.1,p=0.051) and higher satisfaction score(8.8 vs8.0,p=0.12).No significant associations were found between parameters measured by esophagealmanometry (lower esophageal sphincter resting and residual relaxation pressures,peristaltic amplitude and normal peristaltic propagation) and clinical paraineters(dysphagia, heartburn, bloating,and overall satisfaction) for all time points-3 monthspost-operative manometry vs. symptoms at 3 months and 5 years, 5 years post-operativemanometry vs. symptoms at 5 years, except for a weak (r=-0.17, p=0.042) correlationbetween the % of successfully propagated swallows at 3 months, and dysphagia forsolids at 5 years.At 10-years follow-up, no significant differences between the patients with and withoutdivision of short gastric vessel could be identified. Heartburn, dysphagia, and overallsatisfaction were similar for both study groups.ConclusionPartial fundoplication is the better surgical treatment for gastro-esophageal reflux disease.Chinese Herbs, which resulted in lower incidence of post-operative complications, couldbe used routinely after fundoplication.Postoperative esophageal manometry parameters at 3 months and 5 years after surgerywere not associated with any clinically important differences in postoperative symptomsof heartburn, dysphagia, or bloat, or with overall satisfaction with the surgical outcome.The routine use of esophageal manometry to assess outcome following Nissenfundoplication does not predict clinical outcome.There is no benefit for division of the short gastric vessels during laparoscopic Nissenfundoplication.