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Abstract：
Approximately 3-6% of patients undergoing anti-reflux surgery require \"redo\" surgery for persistent gastroesophageal reflux disease (GERD). Further surgery for patients with two failed prior anti-reflux operations is controversial due to the morbidity of reoperation and poor outcomes. We examined our experience with surgical revision of patients with at least two failed anti-reflux operations.
Adults undergoing at least a second-time revision anti-reflux surgery between 1999 and 2017 were eligible. The primary outcomes were general and disease-specific quality-of-life (QoL) scores determined by Short-Form-36 (SF36) and GERD-Health-Related QoL (GERD-HRQL) instruments, respectively. Secondary outcomes included perioperative morbidity and mortality.
Eighteen patients undergoing redo-redo surgery (13 with 2 prior operations, 5 with 3 prior operations) were followed for a median of 6 years [IQR 3, 12]. Sixteen patients (89%) underwent open revisions (14 thoracoabdominal, 2 laparotomy) and two patients had laparoscopic revisions. Indications for surgery included reflux (10 patients), regurgitation (5 patients), and dysphagia (3 patients). Intraoperative findings were mediastinal wrap herniation (9 patients), misplaced wrap (2 patients), mesh erosion (1 patient), or scarring/stricture (6 patients). Procedures performed included Collis gastroplasty + fundoplication (6 patients), redo fundoplication (5 patients), esophagogastrectomy (4 patients), and primary hiatal closure (3 patients). There were no deaths and 13/18 patients (72%) had no postoperative complications. Ten patients completed QoL surveys; 8 reported resolution of reflux, 6 reported resolution of regurgitation, while 4 remained on proton-pump inhibitors (PPI). Mean SF36 scores (± standard deviation) in the study cohort in the eight QoL domains were as follows: physical functioning (79.5 [± 19.9]), physical role limitations (52.5 [± 46.3]), emotional role limitations (83.3 [± 36.1]), vitality (60.0 [± 22.7]), emotional well-being (88.4 [± 8.7]), social functioning (75.2 [± 31.0]), pain (66.2 [± 30.9]), and general health (55.0 [± 39.0]).
An open thoracoabdominal approach in appropriately selected patients needing third-time anti-reflux surgery carries low morbidity and provides excellent results as reflected in QoL scores.
Adults undergoing at least a second-time revision anti-reflux surgery between 1999 and 2017 were eligible. The primary outcomes were general and disease-specific quality-of-life (QoL) scores determined by Short-Form-36 (SF36) and GERD-Health-Related QoL (GERD-HRQL) instruments, respectively. Secondary outcomes included perioperative morbidity and mortality.
Eighteen patients undergoing redo-redo surgery (13 with 2 prior operations, 5 with 3 prior operations) were followed for a median of 6 years [IQR 3, 12]. Sixteen patients (89%) underwent open revisions (14 thoracoabdominal, 2 laparotomy) and two patients had laparoscopic revisions. Indications for surgery included reflux (10 patients), regurgitation (5 patients), and dysphagia (3 patients). Intraoperative findings were mediastinal wrap herniation (9 patients), misplaced wrap (2 patients), mesh erosion (1 patient), or scarring/stricture (6 patients). Procedures performed included Collis gastroplasty + fundoplication (6 patients), redo fundoplication (5 patients), esophagogastrectomy (4 patients), and primary hiatal closure (3 patients). There were no deaths and 13/18 patients (72%) had no postoperative complications. Ten patients completed QoL surveys; 8 reported resolution of reflux, 6 reported resolution of regurgitation, while 4 remained on proton-pump inhibitors (PPI). Mean SF36 scores (± standard deviation) in the study cohort in the eight QoL domains were as follows: physical functioning (79.5 [± 19.9]), physical role limitations (52.5 [± 46.3]), emotional role limitations (83.3 [± 36.1]), vitality (60.0 [± 22.7]), emotional well-being (88.4 [± 8.7]), social functioning (75.2 [± 31.0]), pain (66.2 [± 30.9]), and general health (55.0 [± 39.0]).
An open thoracoabdominal approach in appropriately selected patients needing third-time anti-reflux surgery carries low morbidity and provides excellent results as reflected in QoL scores.
摘要：
大约3-6％接受抗反流手术的患者需要“重做”手术治疗持续性胃食管反流病（GERD）。由于再次手术的发病率和不良预后，对先前两次抗反流手术失败的患者的进一步手术存在争议。我们检查了我们对至少两次抗反流手术失败的患者进行手术翻修的经验。
在1999年至2017年期间接受至少第二次翻修抗反流手术的成年人符合资格。主要结果是通过Short-Form-36（SF36）和GERD-健康相关QoL（GERD-HRQL）工具确定的一般和疾病特异性生活质量（QoL）评分，分别。次要结果包括围手术期发病率和死亡率。
18例接受重做-重做手术的患者（13例，2例先前手术，5例，既往手术3例），中位随访6年[IQR3，12]。16例患者（89%）接受了开腹翻修（14例胸腹，2次剖腹手术）和两名患者进行了腹腔镜翻修。手术适应症包括反流（10例），返流（5例），和吞咽困难（3例）。术中发现纵隔包裹疝（9例），错误放置的包装（2名患者），网眼侵蚀（1名患者），或疤痕/狭窄（6例）。进行的手术包括Collis胃成形术+胃底折叠术（6例），重做胃底折叠术（5例），食管胃切除术（4例），和原发性食管关闭（3例）。无死亡病例，13/18患者（72%）无术后并发症。10名患者完成了QoL调查；8名报告了反流的消退，6报告的反流分辨率，而4例仍在质子泵抑制剂（PPI）上。8个QoL领域的研究队列中的平均SF36得分（±标准差）如下：身体功能（79.5[±19.9]），身体作用限制(52.5[±46.3])，情感角色限制(83.3[±36.1])，活力（60.0[±22.7]），情感幸福感（88.4[±8.7]），社会功能（75.2[±31.0]），疼痛（66.2[±30.9]），和一般健康（55.0[±39.0]）。
在适当选择的需要第三次抗反流手术的患者中，开放胸腹入路的发病率较低，并提供良好的结果，如QoL评分所示。
在1999年至2017年期间接受至少第二次翻修抗反流手术的成年人符合资格。主要结果是通过Short-Form-36（SF36）和GERD-健康相关QoL（GERD-HRQL）工具确定的一般和疾病特异性生活质量（QoL）评分，分别。次要结果包括围手术期发病率和死亡率。
18例接受重做-重做手术的患者（13例，2例先前手术，5例，既往手术3例），中位随访6年[IQR3，12]。16例患者（89%）接受了开腹翻修（14例胸腹，2次剖腹手术）和两名患者进行了腹腔镜翻修。手术适应症包括反流（10例），返流（5例），和吞咽困难（3例）。术中发现纵隔包裹疝（9例），错误放置的包装（2名患者），网眼侵蚀（1名患者），或疤痕/狭窄（6例）。进行的手术包括Collis胃成形术+胃底折叠术（6例），重做胃底折叠术（5例），食管胃切除术（4例），和原发性食管关闭（3例）。无死亡病例，13/18患者（72%）无术后并发症。10名患者完成了QoL调查；8名报告了反流的消退，6报告的反流分辨率，而4例仍在质子泵抑制剂（PPI）上。8个QoL领域的研究队列中的平均SF36得分（±标准差）如下：身体功能（79.5[±19.9]），身体作用限制(52.5[±46.3])，情感角色限制(83.3[±36.1])，活力（60.0[±22.7]），情感幸福感（88.4[±8.7]），社会功能（75.2[±31.0]），疼痛（66.2[±30.9]），和一般健康（55.0[±39.0]）。
在适当选择的需要第三次抗反流手术的患者中，开放胸腹入路的发病率较低，并提供良好的结果，如QoL评分所示。
