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Gehwolf P, Agerer T, Stacul N, Kienzl-Wagner K, Schäfer A, Berchtold V, Cakar-Beck F, Elisabeth G, Wykypiel H. Lap. Nissen fundoplication leads to better respiratory symptom control than Toupet in the long term of 20 years. Langenbecks Arch Surg 2023; 408:372. [PMID: 37737866 PMCID: PMC10517034 DOI: 10.1007/s00423-023-03108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Having performed anti-reflux surgery for thirty years, it was important to reexamine our patients in the long term to enlarge the body of evidence concerning classical and extraesophageal symptoms that are differently controlled by Nissen or Toupet fundoplication. OBJECTIVES We report a cohort of 155 GERD patients who underwent fundoplication within a tailored approach between 1994 and 2000. Changes in the perioperative functional outcome, GERD symptoms, and quality of life are being analyzed 10 and 20 years after the operation. RESULTS The operation resulted in a superior quality of life compared to a patient cohort treated with PPI therapy. We found that both surgical methods (laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication) cure classical symptoms equally (heartburn, regurgitation, and dysphagia). GERD patients receiving a Toupet fundoplication seem more likely to suffer from extraesophageal GERD symptoms 10 and 20 years after surgery than patients with a Nissen fundoplication. On the other hand, some patients with Nissen fundoplication report dysphagia even 10 and 20 years after surgery. CONCLUSION Both the laparoscopic Nissen and Toupet fundoplications provide excellent symptom control in the long term. Moreover, the Nissen fundoplication seems to be superior in controlling extraesophageal reflux symptoms, but at the expense of dysphagia. In summary, tailoring the operation based on symptoms seems advantageous.
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Affiliation(s)
- Philipp Gehwolf
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria.
| | - Teresa Agerer
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Nadine Stacul
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Katrin Kienzl-Wagner
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Aline Schäfer
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Valeria Berchtold
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Fergül Cakar-Beck
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Gasser Elisabeth
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Heinz Wykypiel
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
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Novel technique for retraction of the gastroesophageal junction in laparoscopic antireflux surgery. Surg Laparosc Endosc Percutan Tech 2014; 24:e224-5. [PMID: 24710224 DOI: 10.1097/sle.0b013e31828fa270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Laparoscopic antireflux surgery is a recognized procedure for patients diagnosed with gastroesophageal reflux disease whose symptoms are refractory to medical treatment. We describe a novel and cost-effective technique that aids in mobilization and retraction of the gastroesophageal junction before repair of the diaphragmatic crural defect. After hiatal dissection and creation of a posterior gastric wrap, an index suture (2-0 ethibond) is placed across the wrap. This is used to retract the gastroesophageal junction and expose the crura for repair and "required facilitate fixation of fundus to the crura (fundopexy)." This technique negates the requirement for further instruments thus reducing operative expenditure and offers minimal disruption to the tissue. We have performed over 350 operative procedures using this technique and recommend it as an alternative choice that is cost effective for retraction of the esophagogastric junction in antireflux surgery.
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Lenglinger J, See SF, Beller L, Cosentini EP, Asari R, Wrba F, Riegler M, Schoppmann SF. Review on novel concepts of columnar lined esophagus. Wien Klin Wochenschr 2013; 125:577-90. [PMID: 24061694 DOI: 10.1007/s00508-013-0418-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 07/28/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Columnar lined esophagus (CLE) is a marker for gastroesophageal reflux and associates with an increased cancer risk among those with Barrett's esophagus. Recent studies fostered the development of integrated CLE concepts. METHODS Using PubMed, we conducted a review of studies on novel histopathological concepts of nondysplastic CLE. RESULTS Two histopathological concepts-the squamo-oxyntic gap (SOG) and the dilated distal esophagus (DDE), currently model our novel understanding of CLE. As a consequence of reflux, SOG interposes between the squamous lined esophagus and the oxyntic mucosa of the proximal stomach. Thus the SOG describes the histopathology of CLE within the tubular esophagus and the DDE, which is known to develop at the cost of a shortened lower esophageal sphincter and foster increased acid gastric reflux. Histopathological studies of the lower end of the esophagus indicate, that the DDE is reflux damaged, dilated, gastric type folds forming esophagus and cannot be differentiated from proximal stomach by endoscopy. While the endoscopically visible squamocolumnar junction (SCJ) defines the proximal limit of the SOG, the assessment of the distal limit requires the histopathology of measured multilevel biopsies. Within the SOG, CLE types distribute along a distinct zonation with intestinal metaplasia (IM; Barrett's esophagus) and/or cardiac mucosa (CM) at the SCJ and oxyntocardiac mucosa (OCM) within the distal portion of the SOG. The zonation follows the pH-gradient across the distal esophagus. Diagnosis of SOG and DDE includes endoscopy, histopathology of measured multi-level biopsies from the distal esophagus, function, and radiologic tests. CM and OCM do not require treatment and are surveilled in 5 year intervals, unless they associate with life quality impairing symptoms, which demand medical or surgical therapy. In the presence of an increased cancer risk profile, it is justified to consider radiofrequency ablation (RFA) of IM within clinical studies in order to prevent the progression to dysplasia and cancer. Dysplasia justifies RFA ± endoscopic resection. CONCLUSIONS SOG and DDE represent novel concepts fusing the morphological and functional aspects of CLE. Future studies should examine the impact of SOG and DDE for monitoring and management of gastroesophageal reflux disease (GERD).
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Affiliation(s)
- Johannes Lenglinger
- Manometry Lab & Upper GI Service, Department of Surgery, University Clinic of Surgery, CCC-GET, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Kenngott HG, Müller‐Stich BP, Reiter MA, Rassweiler J, Gutt CN. Robotic suturing: Technique and benefit in advanced laparoscopic surgery. MINIM INVASIV THER 2009; 17:160-7. [DOI: 10.1080/13645700802103381] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kornmo TS, Ruud TE. Long-term results of laparoscopic Nissen fundoplication due to gastroesophageal reflux disease. A ten year follow-up in a low volume center. Scand J Surg 2009; 97:227-30. [PMID: 18812271 DOI: 10.1177/145749690809700304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic 360 degrees nissen fundoplication has been our routine surgical procedure since 1995, in the treatment of gastroesophageal reflux disease (GERD). We have reviewed our results of patients treated with laparoscopic Nissen fundoplication (LNF) during 1995-1998. MATERIAL AND METHODS 170 patients have undergone LNF in our hospital since 1995. during the period of 1995-1998, 33 patients were treated. all patients were asked to return a structured follow-up questionnaire, using a Visick grading scale, after an average of 69 months (2003) and 117 months (2007). 29 questionnaires (90%) were answered in 2003, and 31 questionnaires (97%) were answered in 2007. one patient died at home before the first questionnaire in 2003, and is therefore not included. We present our results on LNF after an observation time of 117 months (range 99-144 months). RESULTS patient satisfaction after LNF is rated as very good or good (Visick 1-2) in 93% in 2003 and 97% in 2007. 97% of the patients would recommend the same treatment to other patients with similar symptoms at ten year follow up. One patient has undergone resurgery during follow up. Daily gas bloat and flatulence is reported in 52% in 2003 and 39% in 2007, and is the most common reason for reduced satisfaction. Five patients report of reflux symptoms, one patient daily and four patients sometimes, where the first patient still uses proton pump inhibitor (PPI) daily and three patients use PPI occasionally. CONCLUSIONS patient satisfaction after LNF treatment for gerd is high at long-term (10 years) follow-up. Bloating and flatulence persistently occurred to a great extent and the need for preoperative information regarding these symptoms is important.
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Affiliation(s)
- T S Kornmo
- Department of Surgery, Sykehuset Asker and Baerum, Rud, Norway.
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Fusco PEB, Poggetti RS, Younes RN, Fontes B, Birolini D. Comparison of Anterior Gastric Wall and Greater Gastric Curvature Invaginations for Weight Loss in Rats. Obes Surg 2007; 17:1340-5. [PMID: 18000725 DOI: 10.1007/s11695-007-9238-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 03/28/2007] [Indexed: 01/07/2023]
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Wykypiel H, Bonatti H, Hinder RA, Glaser K, Wetscher GJ. The laparoscopic fundoplications: Nissen and partial posterior (Toupet) fundoplication. Eur Surg 2006. [DOI: 10.1007/s10353-006-0259-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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