Article record

磁性括约肌增强术与腹腔镜胃底折叠术治疗中大型食管裂孔疝后的长期客观食管裂孔疝复发：一项多中心队列研究

Long-term objective hiatal hernia recurrence after magnetic sphincter augmentation versus laparoscopic fundoplication: a multicenter cohort study of moderate and large hiatal hernias.

临床研究咽喉科IF 3.3Q1

文献信息

PMID	42869970
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Shahin Ayazi 查看其他 9 位作者 F P Buckley；John C Lipham；Philip Woodworth；Mark S Shachner；Carlos J Anciano；Vineeth Sadda；Kate Freeman；Rachel Heidrick；Reginald C W Bell
作者单位	Foregut Division, Department of Surgery, Allegheny Health Network, Pittsburgh, PA, USA. 查看其他 8 条单位信息 Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.；Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, TX, USA.；Division of Upper GI and General Surgery, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA.；Institute of Esophageal and Reflux Surgery, Englewood, CO, USA.；South Florida Surgical Specialists, Coral Springs, FL, USA.；Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA.；Foregut Consulting, Cave Creek, AZ, USA.；Foregut Consulting, Cave Creek, AZ, USA. reg@regbell.com.
期刊	Surgical endoscopy
SCI 分区	Q1
IF	3.3
研究类型	临床研究 · 临床
所属专科	咽喉科

中文摘要

背景： 复发性食管裂孔疝是抗反流手术后长期失败的主要原因，也是再次手术最常见的指征。尽管磁性括约肌增强术（MSA）在中大型食管裂孔疝修补术后已显示出良好结局，但其与腹腔镜胃底折叠术相比的长期解剖耐久性仍不明确。我们通过客观评估术后食管裂孔疝复发，比较了MSA与胃底折叠术在中大型食管裂孔疝患者中修补的耐久性。
方法： 这项多中心观察性队列研究分析了来自六个高容量前肠中心的前瞻性维护登记数据。纳入接受MSA或腹腔镜胃底折叠术对中型（3-5 cm）或大型（>5 cm或食管旁）食管裂孔疝进行初次修补，并在术后3年接受方案指导的客观随访的成年患者。主要结局为客观食管裂孔疝复发。次要结局包括GERD-HRQL、质子泵抑制剂使用、患者满意度和再次手术。
结果： 共有258例患者接受了抗反流手术，其中196例（76.0%）接受MSA治疗，62例（24.0%）接受胃底折叠术。3年时，MSA术后客观食管裂孔疝复发显著低于胃底折叠术（6.1% vs 21.0%；P = 0.002）。在多变量分析中，胃底折叠术与3年客观食管裂孔疝复发显著相关（OR，4.67；95% CI，1.11-19.59；P = 0.035）。尽管MSA术后复发率较低，但两组在GERD-HRQL、吞咽困难、腹胀、患者满意度和再次手术率方面相似，而MSA术后质子泵抑制剂使用较低（11.5% vs 27.5%；P = 0.022）。
结论： 与腹腔镜胃底折叠术相比，MSA与较低的客观食管裂孔疝复发相关，但两组患者报告结局相似。在选择最佳抗反流手术时，应将长期解剖耐久性与患者报告结局一并考虑。

英文摘要

BACKGROUND: Recurrent hiatal hernia is a leading cause of long-term failure after antireflux surgery and the most common indication for revisional surgery. Although magnetic sphincter augmentation (MSA) has demonstrated favorable outcomes following repair of moderate and large hiatal hernias, its long-term anatomical durability compared with laparoscopic fundoplication remains unclear. We compared the durability of hiatal hernia repair following MSA versus fundoplication in patients with moderate and large hiatal hernias using objective assessment of postoperative hiatal hernia recurrence.
METHODS: This multicenter observational cohort study analyzed prospectively maintained registries from six high-volume foregut centers. Adult patients undergoing primary repair of moderate (3-5 cm) or large (> 5 cm or paraesophageal) hiatal hernias with MSA or laparoscopic fundoplication who underwent protocol-directed objective follow-up 3 years after surgery were included. The primary outcome was objective hiatal hernia recurrence. Secondary outcomes included GERD-HRQL, proton pump inhibitor use, patient satisfaction, and revisional surgery.
RESULTS: A total of 258 patients underwent antireflux surgery, including 196 (76.0%) treated with MSA and 62 (24.0%) with fundoplication. At 3 years, objective hiatal hernia recurrence was significantly lower following MSA than fundoplication (6.1% vs 21.0%; P = 0.002). On multivariable analysis, fundoplication was significantly associated with 3-year objective hiatal hernia recurrence (OR, 4.67; 95% CI, 1.11-19.59; P = 0.035). Despite lower recurrence after MSA, GERD-HRQL, dysphagia, bloating, patient satisfaction, and revisional surgery rates were similar between groups, whereas postoperative proton pump inhibitor use was lower following MSA (11.5% vs 27.5%; P = 0.022).
CONCLUSIONS: MSA was associated with lower objective hiatal hernia recurrence than laparoscopic fundoplication, but patient-reported outcomes were similar between procedure groups. Long-term anatomical durability should be considered alongside patient-reported outcomes when selecting the optimal antireflux procedure.