Laparoscopic total (Nissen) versus posterior (Toupet) fundoplication for gastroesophageal reflux disease: a propensity score-matched comparison of the perioperative and 1-year follow-up outcome.

IF 2.6 2区 医学 Q1 SURGERY
Hernia Pub Date : 2024-10-01 Epub Date: 2024-03-17 DOI:10.1007/s10029-024-02988-z
F Köckerling, D Jacob, D Adolf, V Zherdyev, H Riediger, H Scheuerlein
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引用次数: 0

Abstract

Introduction: The debate continues as to whether laparoscopic total Nissen (LNF) versus partial posterior Toupet fundoplication (LTF) leads to better outcomes in the surgical treatment of axial hiatal hernia with gastroesophageal reflux disease. In the most recent meta-analysis including 13 RCTs with 1564 patients, no significant difference was found between the two procedures in terms of perioperative complications and recurrent reflux rates. Further comparative analyses are urgently needed.

Methods: This retrospective analysis of prospectively recorded data from the Herniamed Registry compared the perioperative and 1-year follow-up outcomes after total Nissen versus partial Toupet fundoplication. Propensity score matching was chosen as the statistical method. Matching was performed for n = 2290 pairs.

Results: No systematic discrepancy was found between the Nissen and Toupet fundoplication for any of the outcome parameters (intraoperative complications LNF 2.10% vs LTF 1.48%, general complications 2.27% vs 2.88%, postoperative complications 1.44% vs 1.18%, complication-related reoperation 1.00% vs 0.91%, recurrence on 1-year follow-up 6.55% vs 5.33%, pain on exertion on 1-year follow-up 12.49% vs 9.52%, pain at rest on 1-year follow-up 10.44 vs 9.52% and pain requiring treatment on 1-year follow-up 9.61% vs 8.17%). Also the postoperative dysphagia rate showed with 5.34% after LNF and with 4.64% after LTF no significant difference.

Conclusion: The findings presented here did not show any significant difference up to 1 year after Nissen or Toupet fundoplication. This is in concordance with the findings of the meta-analyses. However, the perioperative and 1-year follow-up outcomes demonstrate that both operation techniques should be carried out by experienced surgeons.

Abstract Image

腹腔镜全胃底折叠术(尼森)与后路折叠术(图佩特)治疗胃食管反流病:围手术期和一年随访结果的倾向得分匹配比较。
导言:关于腹腔镜全尼森胃底折叠术(LNF)与部分后方陶氏胃底折叠术(LTF)在手术治疗伴有胃食管反流疾病的轴向食管裂孔疝方面是否会带来更好的疗效,争论仍在继续。最新的荟萃分析包括 13 项 RCT,共 1564 名患者,结果发现两种手术在围手术期并发症和复发反流率方面无明显差异。因此迫切需要进一步的比较分析:这项回顾性分析是对 Herniamed 登记处记录的前瞻性数据进行的,比较了全尼森胃底折叠术和部分图佩特胃底折叠术的围手术期和 1 年随访结果。统计方法采用倾向评分匹配法。匹配结果为 n = 2290 对:结果:尼森胃底折叠术和图佩特胃底折叠术的任何结果参数均未发现系统性差异(术中并发症 LNF 2.10% vs LTF 1.48%,一般并发症 2.27% vs 2.88%,术后并发症 1.44% vs 1.18%,并发症相关再次手术 1.00% vs 0.91%,1 年随访复发率 6.55% vs 5.33%,1 年随访劳累疼痛率 12.49% vs 9.52%,1 年随访休息疼痛率 10.44% vs 9.52%,1 年随访需要治疗的疼痛率 9.61% vs 8.17%)。此外,术后吞咽困难发生率在 LNF 后为 5.34%,在 LTF 后为 4.64%,两者无明显差异:本文的研究结果显示,尼森胃底折叠术和图佩特胃底折叠术术后一年内没有明显差异。这与荟萃分析的结果一致。不过,围手术期和 1 年随访结果表明,这两种手术技术都应由经验丰富的外科医生实施。
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来源期刊
Hernia
Hernia SURGERY-
CiteScore
4.90
自引率
26.10%
发文量
171
审稿时长
4-8 weeks
期刊介绍: Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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