Abstract: Objective:To investigate the clinical efficacy of laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett′s esophagus.
Methods:The retrospective cross-sectional study was conducted. The clinicopathological data of 12 patients with gastroesophageal reflux disease complicated with Barrett′s esophagus who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between July 2012 to July 2016 were collected. Preoperative tests of patients included distal esophageal manometry and 24-hour pH monitoring, gastroscopy and upper gastroenterography. According to preoperative evaluation of patients, laparoscopic Nissen fundoplication was preferred, and laparoscopic Dor fundoplication was used for patients with discordant esophageal peristalsis function. Observation indicators: (1) surgical and postoperative recovery situations; (2) follow-up: ① subjective changes of reflux symptoms; ② distal esophageal manometry and 24-hour pH monitoring after operation; ③ progression of esophageal mucosal lesions. Patients were followed up using outpatient examination and telephone interview with questionnaire at one month after operation and gastroscopy every 6 months up to June 2018. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range).
Results:(1) Surgical and postoperative recovery situations: of 12 patients, 7 underwent laparoscopic Nissen fundoplication and 5 underwent laparoscopic Dor fundoplication. Seven patients complicated with esophageal hiatal hernia underwent laparoscopic repair of esophageal hiatal hernia, without conversion to open surgery. Operation time, volume of intraoperative blood loss and duration of hospital stay were (98±21)minutes, (27±13)mL, (2.3±1.2)days. There were no intraoperative and postoperative severe complications in the 12 patients. (2) follow-up: 12 patients were followed up for 20-42 months with a average time of 32 months. ① Subjective changes of reflux symptoms: 12 patients completed questionnaires at one month after operation. Scores of heartburn in the 12 patients were 0. Acid regurgitation in the 12 patients was relieved, requiring no acidinhibitory drugs. Upper abdominal dull pain in 3/4 of the patients and retrosternal pain in 2 patients were relieved. Patients had mild dysphagia or abdominal distention at 2 weeks after operation and recovered to normal diet by dietary instruction within 4 weeks. Score of dysphagia was 2 (range, 0-4) and no patient need hospitalization or surgical treatment. Score of surgery satisfaction was 9 (range, 7-10) in the patients. ② Distal esophageal manometry and 24-hour pH monitoring after operation: lower esophageal sphincter pressure and DeMeester score were (12.8±2.8)mmHg (1 mmHg=0.133 kPa) and 11±3 respectively. ③ Progression of esophageal mucosal lesions: 2 of 9 patients with short Barrett′s esophagus were detected complete regression of esophageal mucosal lesions at postoperative one year, 1 was detected partial regression of esophageal mucosal lesions at postoperative one year and 6 were detected no change at postoperative 2 years. One of 3 patients with long Barrett′s esophagus was detected partial regression of esophageal mucosal lesions at postoperative one year and 2 complicated with mild poor differentiation were detected no change at postoperative 2 years.
Conclusion:Laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett′s esophagus can improve subjective symptom and objective markers of patients and provide satisfactory efficacy.