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Nichterosive und erosive gastroösohageale Refluxerkrankung

Langzeitergebnisse der laparoskopischen anterioren Semifundoplikatio

Nonerosive and erosive gastroesophageal reflux disease

Long-term results of laparoscopic anterior semifundoplication

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Zusammenfassung

Hintergrund

Ziel unserer Studie war die Untersuchung der Langzeitergebnisse der laparoskopischen anterioren Semifundoplikatio bei der nichterosiven (NERD) und der erosiven gastroösophagealen Refluxerkrankung (ERD).

Patienten und Methodik

Die Studie umfasst den Zeitraum zwischen Mai 1997 und Juli 2005. Bei allen 190 Patienten wurde präoperativ eine endoskopische Untersuchung des oberen Gastrointestinaltraktes durchgeführt. Der Schweregrad der Refluxösophagitis wurde nach Savary und Miller (Grad I–IV) klassifiziert. Der klinische Verlauf wurde anhand eines standardisierten Fragebogens erfasst. Dabei wurde der modifizierte symptomatische DeMeester-Score bestimmt.

Resultate

Patienten mit NERD (n=83) waren mit 58,5 (27–80) Jahren signifikant älter als Patienten mit ERD (48 [15–84] Jahre) (n=107) (p=0,0001). Im Verlauf wiesen Patienten mit NERD einen geringeren modifizierten symptomatischen DeMeester-Score mit 0 (0–4) Punkten im Vergleich zu Patienten mit ERD auf (1 [0–5] Punkte), jedoch ohne statistische Signifikanz (p=0,151).

Schlussfolgerung

Die laparoskopische anteriore Semifundoplikatio führt bei der NERD und ERD zu ähnlich guten symptomatischen Langzeitergebnissen. Die anteriore Semifundoplikatio ist eine gute Therapieoption bei selektionierten Patienten mit persistierenden refluxassoziierten Symptomen und endoskopisch negativem Nachweis einer Ösophagitis.

Abstract

Background

The aim of this study was to evaluate long-term results of laparoscopic anterior semifundoplication in patients with nonerosive (NERD) and erosive (ERD) gastroesophageal reflux disease.

Patients and Methods

The study includes the period from May 1997 to July 2005. Upper gastrointestinal endoscopy was performed in all 190 patients. The severity of reflux esophagitis was classified according to Savary and Miller (grades I–IV). A standardized questionnaire was used for follow-up, and the modified symptomatic DeMeester score was assessed.

Results

58.5 years of age (range 27–80), patients with nonerosive reflux disease (n=83) were significantly older than those with erosive reflux disease (n=107) (48 years range 15–84) (p=0.0001). Patients with NERD had a lower modified symptomatic DeMeester score postoperatively of 0 (range 0–4) than patients with ERD, of 1 (range 0–5), though without statistical significance (p=0.151).

Conclusion

Laparoscopic anterior semifundoplication leads to comparable symptomatic long-term results in both NERD and ERD. Anterior semifundoplication is a good therapeutic option for selected patients with persistent reflux-associated symptoms and endoscopically negative esophagitis.

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  1. Klinik für Allgemein- und Abdominalchirurgie, Johannes-Gutenberg-Universität, Langenbeckstraße 1, 55131 , Mainz, Deutschland

    I. Gockel, A. Heintz, M. Domeyer, W. Kneist, T. T. Trinh & T. Junginger

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  1. I. Gockel
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  2. A. Heintz
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  3. M. Domeyer
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  4. W. Kneist
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  5. T. T. Trinh
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  6. T. Junginger
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Correspondence to I. Gockel.

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Gockel, I., Heintz, A., Domeyer, M. et al. Nichterosive und erosive gastroösohageale Refluxerkrankung. Chirurg 78, 35–39 (2007). https://doi.org/10.1007/s00104-006-1246-8

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