Meta-analysis of the effect of postoperative recurrence in anti-reflux surgery with protection of vagus

doi:10.3877/cma.j.issn.2095-8765.2020.02.002

Abstract

Abstract:

Objective

To analyze the effect of postoperative recurrence in anti-reflux surgery with protection of vagus.

Methods

Pubmed, web of science, Embase, ScienceDirect, ovid, CNKI database were searched and submitted for search until September 2019. A controlled clinical study comparing with or without vagotomy in anti-reflux surgery of the hiatal hernia was performed. Authors performed literature screening, data extraction and quality assessment. Cochrane 5.1.0 systematic review manual was applied for meta-analysis.

Results

A total of 11 retrospective clinical study were included. All the study were divided into two subgroups according to the methods of diagnosis for the recurrence of hiatal hernia:anatomic recurrence group and clinical recurrence group. More specifically,430 patients with vagotomy and 383 patients without vagotomy were included in anatomic recurrence group,.While 324 cases with vagotomy and 362 cases without vagotomy were analyzed in the other subgroup. The overall analysis of the included studies showed that compared with the non-vagotomy group, vagotomy group had a higher risk of postoperative recurrence of hiatal hernial in both subgroups.(P＜0.0001, OR=1.96, 95%CI: 1.45~2.64 in anatomic recurrence group, P=0.01, RR=1.56, 95%CI: 1.10-2.22 in clinical recurrence group respectively).Combined subgroup analysis shows that the risk of recurrence in vagotomy group is higer than that of non-vagotomy group, with a reletive risk of 1.78, and a 95% confidence interval of 1.42~2.24 (P＜0.00001), and the difference was statistically significant.

Conclusion

Protecting vagus in the procedure of anti-reflux surgery has a beneficial effect on reducing the postoperative recurrence, which deserves to practice in clinic.

Key words: Hiatal hernia, Anti-reflux surgery, Vagotomy, Recurrence, Meta-analysis

Qinwen Tai, Yang Xiao, Jinhui Zhang, Feng Gao, Yuanxi Wang, Liquan Cai, Heng Zhang, Jinhua Huang, Ninglei Li. Meta-analysis of the effect of postoperative recurrence in anti-reflux surgery with protection of vagus[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2020, 07(02): 77-83.

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Figures/Tables 6

References 29

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实验	随访时间	手术方式	迷走神经切断方式	总计(例)	迷走神经非迷走神
实验	随访时间	手术方式	迷走神经切断方式	总计(例)	切断组(例)	经切断组(例)
Vansant 1967	6个月~1年	滑疝修补术	vp	40	37	3
Pearson 1969	1~6年	食管裂孔疝修补术	vp	137	87	50
Woodward 1971	3~6个月	Nissen胃底折叠术	vp	231	98	133
BAHADORZADEH 1974	1~6个月或3年	Nissen胃底折叠术	PCV	29	18	11
Wilson 1974	/	食管裂孔疝修补术	vp	44	21	23
Vansant 1976	＞3年	食管裂孔疝修补术	vp	311	159	152
Mokka 1976	1T1年	Nissen胃底折叠，食管裂孔疝修补	vp	86	17	69
ROURKE 1985	6个月~5年	胃底折叠术	PCV,vp,TGV	56	19	37
Jamieson 1991	4个月~4年	胃底折叠术	PGV	31	11	20
Harish 2007	/	Nissen胃底折叠术、食管裂孔疝修补术	TV	21	10	11
van Rijn 2016	6个月	腹腔镜胃底折叠术	TV	72	13	58

实验	随访时间	手术方式	迷走神经切断方式	总计(例)	迷走神经非迷走神
实验	随访时间	手术方式	迷走神经切断方式	总计(例)	切断组(例)	经切断组(例)
Vansant 1967	6个月~1年	滑疝修补术	vp	40	37	3
Pearson 1969	1~6年	食管裂孔疝修补术	vp	137	87	50
Woodward 1971	3~6个月	Nissen胃底折叠术	vp	231	98	133
BAHADORZADEH 1974	1~6个月或3年	Nissen胃底折叠术	PCV	29	18	11
Wilson 1974	/	食管裂孔疝修补术	vp	44	21	23
Vansant 1976	＞3年	食管裂孔疝修补术	vp	311	159	152
Mokka 1976	1T1年	Nissen胃底折叠，食管裂孔疝修补	vp	86	17	69
ROURKE 1985	6个月~5年	胃底折叠术	PCV,vp,TGV	56	19	37
Jamieson 1991	4个月~4年	胃底折叠术	PGV	31	11	20
Harish 2007	/	Nissen胃底折叠术、食管裂孔疝修补术	TV	21	10	11
van Rijn 2016	6个月	腹腔镜胃底折叠术	TV	72	13	58

研究	随机数列的生成（选择偏倚）	分配隐藏（选择偏倚）	参与者与研究者的双盲（实施偏倚）	研究结局的盲法评价（测量偏倚）	结果数据不完整（随访偏倚）
Vansant 1967	?	?	+	+	?
Pearson 1969	?	?	+	+	+
Woodward 1971	?	?	+	+	?
BAHADORZADEH 1974	?	?	?	+	+
Wilson 1974	?	?	+	+	?
1976 Vansant	?	?	+	+
Mokka 1976	?	?	+	+	?
ROURKE 1985	?	?	+	+	?
Jamieson 1991	?	?	+	+	?
Harish 2007	?	?	?	+	+
van Rijn 2016	?	?	?	+	+

研究	随机数列的生成（选择偏倚）	分配隐藏（选择偏倚）	参与者与研究者的双盲（实施偏倚）	研究结局的盲法评价（测量偏倚）	结果数据不完整（随访偏倚）
Vansant 1967	?	?	+	+	?
Pearson 1969	?	?	+	+	+
Woodward 1971	?	?	+	+	?
BAHADORZADEH 1974	?	?	?	+	+
Wilson 1974	?	?	+	+	?
1976 Vansant	?	?	+	+
Mokka 1976	?	?	+	+	?
ROURKE 1985	?	?	+	+	?
Jamieson 1991	?	?	+	+	?
Harish 2007	?	?	?	+	+
van Rijn 2016	?	?	?	+	+

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