Investigation of Application of Laparoscopic Hiatus Reconstruction with Crurosoft Patch in Elderly Patients with Gastroesophageal Reflux Disease_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

FEI Yang , LI Jiye

Department of General Surgery, The First Affiliated Hospital of PLA General Hospital, Beijing 100048, China;

Corresponding author：

Keywords：

Gastroesophageal reflux disease; Laparoscopy; Fundoplication; Hiatus hernia

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ObjectiveTo investigate the clinical effects of laparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication in elderly patients with gastroesophageal reflux disease (GERD). MethodsFrom July 2006 to July 2009, 22 consecutive elderly patients （≥65 years） with GERD underwent laparoscopic hiatus reconstruction associated with Nissen fundoplication， 10 of them underwent laparoscopic Crurosoft patch hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 8 patients) and 12 underwent laparoscopic simple sutured hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 10 patients). Intra and perioperative data including symptoms (heartburn, regurgitation, dysphagia, and respiratory complications), functional evaluations (esophagogastroscopy, manometric evaluations in lower esophageal segment, and 24 h pH-monitoring values) were compared and analyzed. ResultsPatients in 2 groups had similar preoperative values in demographics, symptom scores, functional evaluations, as well as operative data except for mean operative time. Three-month and 1-year follow-up after operation, the results of symptoms scores and functional evaluations of patients in 2 groups compared with preoperative values wear improved （P lt;0.05）, but symptoms scores and functional evaluations of patients in patch group were evaluated to demonstrate more significant improvement than suture group （P lt;0.05）. In suture group, the results of 3 months after operation were better than 1 year after operation, with statistically significant difference （P lt;0.05）. Two patients underwent postoperative intrathoracic immigration of wrap in suture group, but this complication did not happen in patch group （P lt;0.05）. ConclusionsLaparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication is a safe and effective treatment for elderly patients(≥65 years) with GERD.

Citation： FEI Yang,LI Jiye,.. Investigation of Application of Laparoscopic Hiatus Reconstruction with Crurosoft Patch in Elderly Patients with Gastroesophageal Reflux Disease. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(8): 866-870. doi: Copy

1.	Locke GR 3rd, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux:a populationbased study in olmsted county, Minnesota [J]. Gastroenterology, 1997, 112(5): 14481456.
2.	MoraesFilho JP, Chinzon D, Eisig JN, et al. Prevalence of heartburn and gastroesophageal reflux disease in the urban brazilian population [J]. Arq Gastroenterol, 2005, 42(2): 122127.
3.	汪忠镐，陈秀，韩冰，等．胃食管反流病引起“顽固性哮喘”以致气胸一例报告 [J]．临床误诊误治， 2006， 19（11）： 89．.
4.	Lafullarde T, Watson DI, Jamieson GG, et al. Laparoscopic Nissen fundoplication: fiveyear results and beyond [J]. Arch Surg, 2001, 136(2): 180184.
5.	Bammer T, Hinder RA, Klaus A, et al. Fiveto eightyear outcome of the first laparoscopic nissen fundoplications [J]. J Gastrointest Surg, 2001, 5(1): 4248.
6.	Frantzides CT, Madan AK, Carlson MA, et al. A prospective, randomized trial of laparoscopic polytetrafluoroethylene(PTFE)patch repair vs simple cruroplasty for large hiatal hernia [J]. Arch Surg, 2002, 137(6): 649652.
7.	崔莉红，朱风珍，陈桂敏，等．老年人胃食管反流病食道压力测定和24小时pH监测的临床特点 [J]．中国老年学杂志， 2009， 29（17）： 22462247．.
8.	Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: clinical applications [J]. JAMA, 2002, 287(15): 19821986.
9.	Hazzard WR. Demographic peristalsis. implications of the age wave for gastroenterologists [J]. Gastroenterol Clin North Am, 2001, 30(2): 297311, vii.
10.	汪忠镐，吴继敏，刘建军，等．并发严重肺毁损的胃食管喉气管综合症一例纠误挽治 [J]．临床误诊误治， 2007， 20（9）： 12．.
11.	Collen MJ, Abdulian JD, Chen YK. Gastroesophageal refluxdisease in the elderly: more severe disease that requires aggressive therapy [J]. Am J Gastroenterol, 1995, 90(7): 10531057.
12.	Tutuian R, Vela MF, Shay SS, et al. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring [J]. J Clin Gastroenterol, 2003, 37(3): 206215.
13.	Patti MG, Arcerito M, Tamburini A, et al. Effect of laparoscopic fundoplication on gastroesophageal reflux diseaseinduced respiratory symptoms [J]. J Gastrointest Surg, 2000, 4(2): 143149.
14.	Tobin RW, Pope CE, Pellegrini CA, et al. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis [J]. Am J Respir Crit Care Med, 1998, 158(6): 18041808.
15.	Terry M, Smith CD, Branum GD, et al. Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia [J]. Surg Endosc, 2001, 15(7): 691699.
16.	Granderath FA, Kamolz T, Schweiger UM, et al. Quality of life, surgical outcome, and patient satisfaction three years after laparoscopic nissen fundoplication [J]. World J Surg, 2002, 26(10): 12341238.
17.	Horgan S, Pohl D, Bogetti D, et al. Failed antireflux surgery: what have we learned from reoperations? [J]. Arch Surg, 1999, 134(8): 809815.
18.	Khajanchee YS, Urbach DR, Butler N, et al. Laparoscopic antireflux surgery in the elderly [J]. Surg Endosc, 2002, 16(1): 2530.
19.	Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation herniation: preliminary results of a prospective randomized functional and clinical study [J]. Arch Surg, 2005, 140(1): 4048.
20.	Carlson MA, Condon RE, Ludwig KA, et al. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair [J]. J Am Coll Surg, 1998, 187(3): 227230.

1. Locke GR 3rd, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux:a populationbased study in olmsted county, Minnesota [J]. Gastroenterology, 1997, 112(5): 14481456.
2. MoraesFilho JP, Chinzon D, Eisig JN, et al. Prevalence of heartburn and gastroesophageal reflux disease in the urban brazilian population [J]. Arq Gastroenterol, 2005, 42(2): 122127.
3. 汪忠镐，陈秀，韩冰，等．胃食管反流病引起“顽固性哮喘”以致气胸一例报告 [J]．临床误诊误治， 2006， 19（11）： 89．.
4. Lafullarde T, Watson DI, Jamieson GG, et al. Laparoscopic Nissen fundoplication: fiveyear results and beyond [J]. Arch Surg, 2001, 136(2): 180184.
5. Bammer T, Hinder RA, Klaus A, et al. Fiveto eightyear outcome of the first laparoscopic nissen fundoplications [J]. J Gastrointest Surg, 2001, 5(1): 4248.
6. Frantzides CT, Madan AK, Carlson MA, et al. A prospective, randomized trial of laparoscopic polytetrafluoroethylene(PTFE)patch repair vs simple cruroplasty for large hiatal hernia [J]. Arch Surg, 2002, 137(6): 649652.
7. 崔莉红，朱风珍，陈桂敏，等．老年人胃食管反流病食道压力测定和24小时pH监测的临床特点 [J]．中国老年学杂志， 2009， 29（17）： 22462247．.
8. Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: clinical applications [J]. JAMA, 2002, 287(15): 19821986.
9. Hazzard WR. Demographic peristalsis. implications of the age wave for gastroenterologists [J]. Gastroenterol Clin North Am, 2001, 30(2): 297311, vii.
10. 汪忠镐，吴继敏，刘建军，等．并发严重肺毁损的胃食管喉气管综合症一例纠误挽治 [J]．临床误诊误治， 2007， 20（9）： 12．.
11. Collen MJ, Abdulian JD, Chen YK. Gastroesophageal refluxdisease in the elderly: more severe disease that requires aggressive therapy [J]. Am J Gastroenterol, 1995, 90(7): 10531057.
12. Tutuian R, Vela MF, Shay SS, et al. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring [J]. J Clin Gastroenterol, 2003, 37(3): 206215.
13. Patti MG, Arcerito M, Tamburini A, et al. Effect of laparoscopic fundoplication on gastroesophageal reflux diseaseinduced respiratory symptoms [J]. J Gastrointest Surg, 2000, 4(2): 143149.
14. Tobin RW, Pope CE, Pellegrini CA, et al. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis [J]. Am J Respir Crit Care Med, 1998, 158(6): 18041808.
15. Terry M, Smith CD, Branum GD, et al. Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia [J]. Surg Endosc, 2001, 15(7): 691699.
16. Granderath FA, Kamolz T, Schweiger UM, et al. Quality of life, surgical outcome, and patient satisfaction three years after laparoscopic nissen fundoplication [J]. World J Surg, 2002, 26(10): 12341238.
17. Horgan S, Pohl D, Bogetti D, et al. Failed antireflux surgery: what have we learned from reoperations? [J]. Arch Surg, 1999, 134(8): 809815.
18. Khajanchee YS, Urbach DR, Butler N, et al. Laparoscopic antireflux surgery in the elderly [J]. Surg Endosc, 2002, 16(1): 2530.
19. Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation herniation: preliminary results of a prospective randomized functional and clinical study [J]. Arch Surg, 2005, 140(1): 4048.
20. Carlson MA, Condon RE, Ludwig KA, et al. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair [J]. J Am Coll Surg, 1998, 187(3): 227230.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Investigation of Application of Laparoscopic Hiatus Reconstruction with Crurosoft Patch in Elderly Patients with Gastroesophageal Reflux Disease

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