背景:尽管长期效果很好,一小部分接受胃底折叠联合食管裂孔疝修补术(腹腔镜抗反流手术[ARS])治疗胃食管反流病(GERD)的患者可能需要再次手术.在出现症状复发的患者中,食管胃十二指肠镜检查(EGD)评估通过确认胃底折叠术的失败并揭示失败的模式,在redo-ARS的手术计划中起着至关重要的作用。我们旨在比较外部内窥镜医师记录的发现(即,外部医生)到内部内窥镜医师记录的那些(即,手术前肠或胸外科医师)在重做ARS之前。
方法:IRB批准后,我们对2016年11月至2023年3月在三级外科中心接受redo-ARS的患者进行了回顾性图表回顾.包括有外部和内部EGD报告的患者,并对两份报告的结果进行了比较。
结果:在197例接受redo-ARS的患者中,这两份术前EGD报告均有181例(136例[75.1%]女性;中位年龄,61岁[IQR53-69];BMI中位数,27.9千克/平方米[IQR24.9-31.3])。原发性和重做ARS之间的中位时间为89个月(IQR38-153),外部和内部内镜评估的中位时间为5个月(IQR2-12).只有38.9%的外部报告提到了先前的胃底折叠术。与手术医生相比,外部医生报告巴雷特食管的比例明显较低(52.4%,p<.001),滑脱胃底并发症(28.8%,p<.001),食管旁疝(20.5%,p<.001),破坏的胃底折叠(20%,p<.001),胸内胃底折叠(0%,p<.001),和扭曲的胃底折叠(0%,p<.001)。
结论:外部内镜医师关于胃底折叠失败的报告通常不完整且缺乏相关细节。非手术内窥镜医师和有经验的外科医生之间的差异可能是由于缺乏准确识别和记录胃底折叠改变的培训和经验。为了缩小这个差距,我们强烈建议采用描述胃底折叠术后内镜变化的标准定义,并在教育项目中纳入相关培训.
BACKGROUND: Despite excellent long-term outcomes, a small proportion of patients who undergo fundoplication with hiatal hernia repair (laparoscopic antireflux surgery [ARS]) for treatment of gastroesophageal reflux disease (GERD) may require reoperation. Esophagogastroduodenoscopy (EGD) assessment in patients presenting with symptom recurrence plays a critical role in surgical planning of redo-ARS by confirming failure of the fundoplication and revealing the pattern of failure. We aimed to compare the findings documented by external endoscopists (i.e., outside physicians) to those documented by internal endoscopists (i.e., operating foregut or thoracic surgeons) before redo-ARS.
METHODS: After IRB approval, we conducted a retrospective chart review of patients who underwent redo-ARS at a tertiary surgical center between November 2016 and March 2023. Patients with both external and internal EGD reports were included, and findings from the two reports were compared.
RESULTS: Of 197 patients who underwent redo-ARS, both preoperative EGD reports were available for 181 (136 [75.1%] women; median age, 61 years [IQR 53-69]; median BMI, 27.9 kg/m2 [IQR 24.9-31.3]). The median time between primary and redo-ARS was 89 months (IQR 38-153), and the median time between external and internal endoscopic evaluation was 5 months (IQR 2-12). Only 38.9% of external reports mentioned a prior fundoplication. Compared to the operating surgeons, external physicians reported a significantly lower proportion of Barrett\'s esophagus (52.4%, p < .001), slipped fundoplications (28.8%, p < .001), paraesophageal hernias (20.5%, p < .001), disrupted fundoplications (20%, p < .001), intrathoracic fundoplications (0%, p < .001), and twisted fundoplications (0%, p < .001).
CONCLUSIONS: External endoscopists\' reports of failed fundoplications are often incomplete and lack relevant details. Discrepancies between nonsurgical endoscopists and experienced surgeons are likely explained by a lack of training and experience to discern and document fundoplication changes accurately. To reduce this gap, we strongly recommend the adoption of standard definitions describing post-fundoplication endoscopic changes and the inclusion of relevant training within educational programs.