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Habeeb TA, Hussain A, Podda M, Aiolfi A, Kryvoruchko IA, Kalmoush AE, Labib MF, Mustafa FM, Elbelkasi H, Hamdy A, Abo Alsaad MI, Sallam AM, Zaitoun MA, Negm M, Mostafa A, Abdou Yassin M, Elshahidy TM, Abdelmonem Elsayed A, Mansour MI, Elaidy MM, Moursi AM, Yehia AM, Ashour H, Metwalli AEM, Abdelhady WA, Abdelghani AA, AbdAllah ES, Ramadan A, Rushdy T. Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study. Int J Surg 2023; 109:3312-3321. [PMID: 37566907 PMCID: PMC10651251 DOI: 10.1097/js9.0000000000000659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Laparoscopic Nissen fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (>5 cm) with severe GERD (DeMeester score >100). MATERIALS AND METHODS This is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery. RESULTS Three hundred sixty patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9 vs. 8.3%) and recurrent regurgitation (2.2 vs. 5%) showed a lower incidence in the LNF+ group ( P =0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0 vs. 3.3% and 0 vs. 2.8% cases in the LNF+ and LNF groups, respectively ( P =0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75 vs. 5.6% and 0 vs. 3.9% of patients ( P =0.001). Score III postoperative persistent dysphagia was 0 vs. 2.8% in the two groups ( P =0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3 vs. 86.7% in both cohorts, respectively ( P =0.05). CONCLUSIONS Intraoperative high-resolution manometry and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint.
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Affiliation(s)
- Tamer A.A.M. Habeeb
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant’Ambrogio, University of Milan, Milan, Italy
| | | | | | - Mohamed F. Labib
- General Surgery Department, Faculty of Medicine, Al-Azher University, Egypt
| | - Fawzy M. Mustafa
- General Surgery Department, Faculty of Medicine, Al-Azher University, Egypt
| | - Hamdi Elbelkasi
- General Surgery Department, Mataryia Teaching Hospital, Egypt
| | - Ahmed Hamdy
- Department of Hepato-Bilio-Pancreatic (HBP) Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | - Ahmed M. Sallam
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed A. Zaitoun
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Negm
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Abdelshafy Mostafa
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Abdou Yassin
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tamer M. Elshahidy
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed I. Mansour
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mostafa M. Elaidy
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Adel Mahmoud Moursi
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M. Yehia
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hassan Ashour
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Waleed A. Abdelhady
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amr. A. Abdelghani
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ehab S. AbdAllah
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Alaaedin Ramadan
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tamer Rushdy
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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