背景:尼森胃底折叠术被认为是食管裂孔疝修补术的基础手术治疗方法。BelseyMarkIV(BMIV)经胸胃底折叠术是一种替代方法,在当今的微创时代很少使用。本研究旨在总结BMIV的安全性和有效性,并将其与Nissen胃底折叠术进行比较。
方法:我们搜索了MEDLINE,Scopus,和CochraneLibrary数据库,用于单臂和比较研究,于3月31日出版,2022年,根据PRISMA声明。使用逆方差权重来估计经历研究结果的患者比例,并进行随机效应荟萃分析。
结果:确定了17项研究,纳入2136和638例接受BelseyMarkIV或Nissen胃底折叠术的患者,分别。使用BMIV技术进行胃底折叠术的患者中,共有13.8%(95%CI:9.6-18.6)的症状无法缓解,而3.5%(95%CI:2.0-5.4)需要再次手术。总的来说,14.8%(95%CI:9.5-20.1)的BMIV手臂患者经历了术后并发症,5.0%(95%CI:2.0-9.0)出现慢性术后疼痛,6.9%(95%CI:3.1-11.9)出现疝气复发。在介入后症状不能解决方面,BelseyMarkIV和Nissen胃底折叠术之间没有观察到统计学上的显着差异(比值比[OR]:1.49[95%置信区间(95CI):0.6-4.0];p=0.42),术后并发症(OR:0.83,95CI:0.5-1.5,p=0.54)和住院死亡率(OR:0.69,95CI:0.13-3.80,p=0.67)。BelseyMarkIV手臂的再手术率明显低于Nissen手臂(OR:0.28,95CI:0.1-0.7,p=0.01)。
结论:BMIV胃底折叠术是安全有效的,但在技术上具有挑战性。与腹腔镜Nissen胃底折叠术相比,BMIV技术可能会给患者带来好处。这些好处,然而,受到开胸手术发病率增加的挑战。
Nissen fundoplication is considered the cornerstone surgical treatment for hiatal hernia repair. Belsey Mark IV (BMIV) transthoracic fundoplication is an alternative approach that is rarely utilized in today\'s minimally invasive era. This study aims to summarize the safety and efficacy of BMIV and to compare it with Nissen fundoplication.
We searched MEDLINE, Scopus, and Cochrane Library databases for single arm and comparative studies published by March 31st, 2022, according to PRISMA statement. Inverse-variance weights were used to estimate the proportion of patients experiencing the studied outcome and random-effects meta-analyses were performed.
17 studies were identified, incorporating 2136 and 638 patients that underwent Belsey Mark IV or Nissen fundoplication, respectively. A total of 13.8% (95% CI: 9.6-18.6) of the patients that underwent fundoplication with the BMIV technique had non-resolution of their symptoms and 3.5% (95% CI: 2.0-5.4) required a reoperation. Overall, 14.8% (95% CI: 9.5-20.1) of the BMIV arm patients experienced post-operative complications, 5.0% (95% CI: 2.0-9.0) experienced chronic postoperative pain and 6.9% (95% CI: 3.1-11.9) had a hernia recurrence. No statistically significant difference was observed between Belsey Mark IV and Nissen fundoplication in terms of post-interventional non-resolution of symptoms (odds ratio [OR]: 1.49 [95% Confidence Interval (95%CI):0.6-4.0]; p = 0.42), post-operative complications (OR:0.83, 95%CI: 0.5-1.5, p = 0.54) and in-hospital mortality (OR:0.69, 95%CI: 0.13-3.80, p = 0.67). Belsey Mark IV arm had significantly lower reoperation rates compared to Nissen arm (OR:0.28, 95%CI: 0.1-0.7, p = 0.01).
BMIV fundoplication is a safe and effective but technically challenging. The BMIV technique may offer benefits to patients compared to the laparoscopic Nissen fundoplication. These benefits, however, are challenged by the increased morbidity of a thoracotomy.