Background

Revision laparoscopic anti-reflux surgery (RLARS) is effective in alleviating the typical symptoms of gastroesophageal reflux disease (GERD). RLARS outcomes in patients with atypical GERD symptoms has not been well established. A composite Reflux Symptom Index (RSI) score greater than 13 indicates extraesophageal manifestation of pathological reflux. In this study, we analyzed the differences in quality-of-life (QOL) and perioperative outcomes between patients with atypical versus typical GERD who underwent RLARS.

Methods

A retrospective review was conducted of a prospectively maintained database of patients with pathologic reflux who underwent RLARS from February 2003 to October 2019. The cohort was divided into two groups, those with typical versus atypical manifestations of GERD, as defined by their RSI score. Patients with a RSI score of > 13 were assigned to the Atypical group and those ≤ 13 were assigned to the Typical group. Patient QOL outcomes were prospectively followed using the RSI survey. Significance was defined by p-value less than 0.05.

Results

A total of 133 patients (Typical 61, Atypical 72) were included in the final analysis. The two groups were similar (p > 0.05) in mean age (58.1 ± 13.3 vs. 55.3 ± 15.5 years), body mass index (29.6 ± 5.0 vs. 30.3 ± 5.4), female sex distribution (60.7% vs. 59.7%) and age adjusted Charlson score (1.76 ± 1.58 vs. 1.98 ± 1.94). The Typical group had a higher frequency of type III hiatal hernia (62.3% vs. 29.2%) and Collis gastroplasty (29.5% vs. 5.6%). The groups had similar rates of partial and complete fundoplication with similar median length of stay (Typical: 3.0 ± 3.4 days vs. Atypical: 2.4 ± 1.7 days). After a mean follow-up of 30.2 ± 33.6 months, both groups reported similar rates of improvement in RSI outcome from baseline (58.1% vs 43.3%, p = .149). However, the RSI outcome at the latest follow-up for the Typical group was significantly better than the Atypical group after RLARS (2.8 ± 5.3 vs. 15.9 ± 11.1, respectively).

Conclusion

Patients who undergo revision paraesophageal hernia repair with objective findings of GERD and subjective complaints of atypical reflux symptoms may show long-term improvement in QOL outcomes. However, these results are contingent on proper patient selection and a thorough work-up for pathological reflux in this population. Further research is needed to determine universal diagnostic criteria to assist in the early detection and surgical treatment of patients with atypical GERD.

中文翻译：

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典型和非典型反流患者的食管旁疝修补术结果

背景

修订腹腔镜抗反流手术 (RLARS) 可有效缓解胃食管反流病 (GERD) 的典型症状。具有非典型 GERD 症状的患者的 RLARS 结果尚未确定。综合反流症状指数 (RSI) 评分大于 13 表示病理性反流的食管外表现。在这项研究中，我们分析了接受 RLARS 治疗的非典型 GERD 患者与典型 GERD 患者在生活质量 (QOL) 和围手术期结果方面的差异。

方法

对 2003 年 2 月至 2019 年 10 月接受 RLARS 的病理性反流患者的前瞻性维护数据库进行了回顾性审查。根据 RSI 评分定义，该队列分为两组，即具有典型和非典型 GERD 表现的组。RSI 评分 > 13 的患者被分配到非典型组，≤ 13 的患者被分配到典型组。使用 RSI 调查前瞻性地跟踪患者 QOL 结果。显着性由小于 0.05 的 p 值定义。

结果

最终分析共包括 133 名患者（典型 61 名，非典型 72 名）。两组 在平均年龄（58.1 ± 13.3 对 55.3 ± 15.5 岁）、体重指数（29.6 ± 5.0 对 30.3 ± 5.4）、女性性别分布（60.7% 对 59.7%）方面相似 ( p > 0.05 )和年龄调整后的 Charlson 评分（1.76 ± 1.58 对 1.98 ± 1.94）。典型组发生 III 型食管裂孔疝（62.3% 对 29.2%）和 Collis 胃成形术（29.5% 对 5.6%）的频率更高。这些组的部分和完全胃底折叠术率相似，中位住院时间相似（典型：3.0 ± 3.4 天与非典型：2.4 ± 1.7 天）。平均随访 30.2 ± 33.6 个月后，两组报告 RSI 结果较基线改善率相似（58.1% 对 43.3%，p =.149）。然而，在 RLARS 后，典型组在最近一次随访时的 RSI 结果明显好于非典型组（分别为 2.8 ± 5.3 和 15.9 ± 11.1）。

结论

接受食管旁疝修补术并伴有 GERD 客观发现和非典型反流症状的主观主诉的患者可能会显示 QOL 结果的长期改善。然而，这些结果取决于适当的患者选择和对该人群病理性反流的彻底检查。需要进一步研究以确定通用诊断标准，以协助非典型 GERD 患者的早期发现和手术治疗。