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De Ponthaud C, Voron T, Paye F. Laparoscopic floppy Nissen fundoplication with valve calibration: a safe and efficient procedure. Surg Today 2024:10.1007/s00595-024-02817-x. [PMID: 38589734 DOI: 10.1007/s00595-024-02817-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 04/10/2024]
Abstract
PURPOSES A floppy Nissen fundoplication with valve calibration (FNF-VC) performed by laparotomy has been described, to reduce postoperative dysphagia and gas bloating after 360°-fundoplication. As laparoscopy is the gold standard for fundoplication, this study reports the first results of a modified FNF-VC adapted for laparoscopy (LFNF). METHODS Seventy-two consecutive patients, who underwent LFNF for refractory GERD between 2012 and 2021, were included. Postoperative outcomes and quality of life (QoL) by GERSS, GERD-HRQL, and GIQLI scores before and after surgery were assessed. RESULTS The main symptoms were pyrosis (81%), regurgitation (39%), Ear-Nose-Throat symptoms (22%), and thoracic pain (24%). Hiatal hernia was present in 85% (n = 61) of the patients. There was no postoperative mortality, and the severe postoperative morbidity rate (Dindo-Clavien ≥ III) was 6%. After a median follow-up of 3.6 years, only 8% of patients were still taking proton-pump inhibitors. Long-term residual dysphagia was noted in 15% of the patients, but none required reoperation or interventional endoscopic procedures. QoL improved, with a significant reduction in GERSS and GERD-HRQL scores and a postoperative GIQLI of 101.75 (75-117.5). CONCLUSION This series reports the safety and efficacy of an FNF-VC adapted for laparoscopy to treat GERD with a limited rate of residual dysphagia.
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Affiliation(s)
- Charles De Ponthaud
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France
- Sorbonne University, Paris, France
| | - Thibault Voron
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France
- Sorbonne University, Paris, France
| | - François Paye
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Hôpital Saint Antoine, Assistance Publique Hôpitaux de Paris, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.
- Sorbonne University, Paris, France.
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2
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Mu SZ, Saber AA. Gastroesophageal Reflux Disease and Weight Loss After Fundoplication Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2024; 34:318-329. [PMID: 38109011 DOI: 10.1007/s11695-023-06927-2] [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: 08/16/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Fundoplication sleeve gastrectomy (FSG) is a novel bariatric procedure that combines anti-reflux fundoplication with sleeve gastrectomy (SG) to simultaneously address gastroesophageal reflux disease (GERD) and obesity. We performed a systematic review and meta-analysis to quantify the prevalence of postoperative GERD and amount of weight loss after FSG. METHODS We searched PubMed, Embase, and Web of Science Core Collection in May 2023 for full-text reports of case series, registries, cohort studies, and randomized clinical trials that reported postoperative GERD and percent excess weight loss (%EWL) after FSG for patients with preoperative GERD and obesity, excluding reports including patients with previous history of bariatric procedures. We used random effects models to estimate postoperative GERD prevalence and %EWL. Risk of bias and evidence quality were assessed with the ROBINS-I and GRADE frameworks (PROSPERO CRD42023420067). RESULTS Of the 935 records initially identified, 13 studies from 8 countries met our inclusion criteria. The prevalence of postoperative GERD pooled from 418 patients was 4.8% (95% CI: 2.8 to 8.4%). Pooled %EWL, available for 225 patients from 7 studies, was 67.8% (95% CI: 55.2 to 80.5). The overall quality of evidence was low, largely due to observational study design, lack of blinded outcome assessment, and evidence of publication bias. CONCLUSION Fundoplication sleeve gastrectomy is an emerging surgical approach for patients with obesity and GERD with promising initial outcomes. Additional studies of efficacy and safety are needed to compare FSG and its technical variations with other weight loss procedures.
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Affiliation(s)
- Scott Z Mu
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alan A Saber
- Department of Surgery, Division of Bariatric and Metabolic Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave., F4, Newark, New Jersey, 07112, USA.
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Salvador R, Vittori A, Capovilla G, Riccio F, Nezi G, Forattini F, Provenzano L, Nicoletti L, Moletta L, Costantini A, Valmasoni M, Costantini M. Antireflux Surgery's Lifespan: 20 Years After Laparoscopic Fundoplication. J Gastrointest Surg 2023; 27:2325-2335. [PMID: 37580489 PMCID: PMC10661768 DOI: 10.1007/s11605-023-05797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/29/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Renato Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy.
| | - Arianna Vittori
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Giovanni Capovilla
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Federica Riccio
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Giulia Nezi
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Francesca Forattini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Luca Provenzano
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Loredana Nicoletti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Lucia Moletta
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Andrea Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
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Peristeri DV, Room H, Tsironis D, Vasilikostas G, Wan A. Long-term efficacy of total versus posterior partial fundoplication in patients with gastro-oesophageal reflux disease: a systematic review and meta-analysis. Ann R Coll Surg Engl 2023. [PMID: 37843095 DOI: 10.1308/rcsann.2023.0046] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Laparoscopic fundoplication remains the standard treatment for patients with severe gastro-oesophageal reflux disease (GORD). Multiple randomised controlled trials (RCTs) have compared the two most commonly performed surgical techniques, total and posterior partial fundoplication (Nissen [NF] and Toupet [TF]), in terms of symptom control and treatment failure in patients without subsequent dysmotility disorders. We aimed to conduct a systematic review and meta-analysis of these two techniques with regard to the long-term effect on reflux control and associated dysphagia. METHODS The MEDLINE®, Embase®, PubMed® and Cochrane Library databases were searched, and all the relevant published RCTs were shortlisted according to the inclusion criteria. The summated outcomes of long-term results relating to the recurrence of GORD and dysphagia were evaluated in a meta-analysis using RevMan software. RESULTS Eight studies (all RCTs) on 1,545 patients undergoing NF or TF were eligible for inclusion in this meta-analysis. There were 799 patients in the NF group and 746 in the TF group. In the random effects model analysis, the incidence of long-term recurrence of GORD was not statistically different between the NF and TF cohorts (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.34-1.41, z=1.01, p=0.31). However, the incidence of long-term dysphagia was statistically lower in the TF group (OR: 2.92, 95% CI: 1.49-5.72, z=3.13, p=0.002) with low between-study heterogeneity (I2=0%). CONCLUSIONS The findings of this systematic review and meta-analysis on symptomatic GORD appear to be in favour of partial posterior fundoplication (TF) as the optimal treatment. It provides equivalent outcomes in reflux symptom control with a lower risk of postoperative dysphagia compared with total fundoplication (NF).
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Affiliation(s)
- D V Peristeri
- St George's University Hospitals NHS Foundation Trust, UK
| | - H Room
- St George's University Hospitals NHS Foundation Trust, UK
| | - D Tsironis
- St George's University Hospitals NHS Foundation Trust, UK
| | - G Vasilikostas
- St George's University Hospitals NHS Foundation Trust, UK
| | - A Wan
- St George's University Hospitals NHS Foundation Trust, UK
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Hajjar A, Verhoeff K, Jogiat U, Mocanu V, Birch DW, Switzer NJ, Wong C, Karmali S. Endoscopic plication compared to laparoscopic fundoplication in the treatment of gastroesophageal reflux disease: a systematic review and meta-analysis. Surg Endosc 2023:10.1007/s00464-023-10202-x. [PMID: 37407715 DOI: 10.1007/s00464-023-10202-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Endoscopic plication offers an alternative to surgical fundoplication for treatment of gastroesophageal reflux disease (GERD). This systematic review and meta-analysis evaluate outcomes following endoscopic plication compared to laparoscopic fundoplication. METHODS AND PROCEDURES Systematic search of MEDLINE, Embase, Scopus, and Web of Science was conducted in September 2022. Study followed PRISMA guidelines. Studies comparing endoscopic plication to laparoscopic fundoplication with n > 5 were included. Primary outcome was PPI cessation, with secondary outcomes including complications, procedure duration, length of stay, change in lower esophageal sphincter (LES) tone, and DeMeester score. RESULTS We reviewed 1544 studies, with five included comparing 105 (46.1%) patients receiving endoscopic plication (ENDO) to 123 (53.9%) undergoing laparoscopic fundoplication (LAP). Average patient age was 47.6 years, with those undergoing plication being younger (46.4 ENDO vs 48.5 LAP). BMI (26.6 kg/m2 ENDO vs 26.2 kg/m2 LAP), and proportion of females (42.9% ENDO vs 37.4% LAP) were similar. Patients undergoing laparoscopic procedures had worse baseline LES pressure (12.8 mmHg ENDO vs 9.0 mmHg LAP) and lower preoperative DeMeester scores (34.6 ENDO vs. 34.1 LAP). The primary outcome demonstrated that 89.2% of patients undergoing laparoscopic fundoplication discontinued PPI compared to 69.4% for those receiving plication. Meta-analysis revealed that plication had significantly reduced odds of PPI discontinuation (OR 0.27, studies = 3, 95% CI 0.12 to 0.64, P = 0.003, I2 = 0%). Secondary outcomes demonstrated that odds of complications (OR 1.46, studies = 4, 95% CI 0.34 to 6.32, P = 0.62, I2 = 0%), length of stay (MD - 1.37, studies = 3, 95% CI - 3.48 to 0.73, P = 0.20, I2 = 94%), and procedure durations were similar (MD 0.78, studies = 3, 95% CI - 39.70 to 41.26, P = 0.97, I2 = 98%). CONCLUSIONS This is the first meta-analysis comparing endoscopic plication to laparoscopic fundoplication. Results demonstrate greater likelihood of PPI discontinuation with laparoscopic fundoplication with similar post-procedural risk.
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Affiliation(s)
- Alexander Hajjar
- Department of Surgery, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada.
| | - Uzair Jogiat
- Department of Surgery, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Noah J Switzer
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Clarence Wong
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
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Lee Y, Tahir U, Tessier L, Yang K, Hassan T, Dang J, Kroh M, Hong D. Long-term outcomes following Dor, Toupet, and Nissen fundoplication: a network meta-analysis of randomized controlled trials. Surg Endosc 2023:10.1007/s00464-023-10151-5. [PMID: 37308760 DOI: 10.1007/s00464-023-10151-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/20/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND In the surgical management of GERD, the traditional procedure is laparoscopic total (Nissen) fundoplication. However, partial fundoplication has been advocated as providing similar reflux control while potentially minimizing dysphagia. The comparative outcomes of different approaches to fundoplication are a topic of ongoing debate and long-term outcomes remain uncertain. This study aims to compare long-term gastroesophageal reflux disease (GERD) related outcomes following different fundoplication procedures. METHODS MEDLINE, EMBASE, PubMed, and CENTRAL databases were searched up to November 2022 to identify randomized controlled trials (RCTs) comparing different types of fundoplications reporting long-term (> 5 years) outcomes. The primary outcome was incidence of dysphagia. Secondary outcomes included incidence of heartburn/reflux, regurgitation, inability to belch, abdominal bloating, reoperation, and patient satisfaction. DataParty, which uses Python 3.8.10 was used to perform the network meta-analysis. We evaluated the overall certainty of evidence with the GRADE framework. RESULTS 13 RCTs were included, with 2063 patients across Nissen (360°), Dor (anterior 180°-200°), and Toupet (posterior 270°) fundoplications. Network estimates demonstrated that Toupet had lower incidence of dysphagia compared to Nissen (OR 0.285; 95% CrI 0.06-0.958). There were no differences in dysphagia between Toupet and Dor (OR 0.473, 95% CrI 0.072-2.835) or between Dor and Nissen (OR 1.689, 95% CrI 0.403-7.699). The three fundoplication types were comparable in all other outcomes. CONCLUSIONS All three approaches of fundoplication share similar long-term outcomes, with the Toupet fundoplication likely providing the best long-term durability with lowest odds of developing postoperative dysphagia.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Umair Tahir
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Lea Tessier
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Kevin Yang
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Taaha Hassan
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Jerry Dang
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.
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Enciso BM, Stadsvold B, Bolduc AR, Hilton RL. Laparoscopic Paraesophageal Hernia Repair With Nissen Fundoplication in a Patient With Ancient Schwannoma of the Gastroesophageal Junction. Am Surg 2023:31348231162701. [PMID: 36888975 DOI: 10.1177/00031348231162701] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Schwannomas are mostly benign tumors that originate from Schwann cells and are rarely seen in the gastrointestinal tract. Our patient is a 65-year-old female who was found to have a 1.5 cm lesion at the gastroesophageal junction, which was clipped and excised on endoscopy. Histologic examination demonstrated an ancient schwannoma. Two years afterward, she presented to our clinic for a large type III paraesophageal hernia. We took her to the operating room for a laparoscopic paraesophageal hernia repair and Nissen fundoplication. We performed an upper endoscopy during the case and found no recurrence of the ancient schwannoma. The case progressed well without complications. She was discharged on postoperative day 1 after tolerating a pureed diet and reported no issues in follow-up. In summary, we demonstrate a successful surgical outcome in a patient who had undergone resection of this rare tumor 2 years prior to her surgery.
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Affiliation(s)
- Benjamin M Enciso
- 1421Medical College of Georgiaat Augusta University Medical Center, Department of Surgery, Augusta, GA, USA
| | - Brianna Stadsvold
- 1421Medical College of Georgiaat Augusta University Medical Center, Department of Surgery, Augusta, GA, USA
| | - Aaron R Bolduc
- 1421Medical College of Georgiaat Augusta University Medical Center, Department of Surgery, Augusta, GA, USA
| | - Renee L Hilton
- 1421Medical College of Georgiaat Augusta University Medical Center, Department of Surgery, Augusta, GA, USA
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Montalva L, Carricaburu E, Sfeir R, Fouquet V, Khen-Dunlop N, Hameury F, Panait N, Arnaud A, Lardy H, Schmitt F, Piolat C, Lavrand F, Ballouhey Q, Scalabre A, Hervieux E, Michel JL, Germouty I, Buisson P, Elbaz F, Lecompte JF, Petit T, Guinot A, Abbo O, Sapin E, Becmeur F, Forgues D, Pons M, Kamdem AF, Berte N, Auger-Hunault M, Benachi A, Bonnard A. Anti-reflux surgery in children with congenital diaphragmatic hernia: A prospective cohort study on a controversial practice. J Pediatr Surg 2022; 57:826-833. [PMID: 35618494 DOI: 10.1016/j.jpedsurg.2022.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Gastro-esophageal reflux disease (GERD) is the most frequent long-term morbidity of congenital diaphragmatic hernia (CDH) survivors. Performing a preventive fundoplication during CDH repair remains controversial. This study aimed to: (1) Analyze the variability in practices regarding preventive fundoplication; (2) Identify predictive factors for fundoplication. (3) Evaluate the impact of preventive fundoplication on gastro-intestinal outcomes in children with a CDH patch repair; METHODS: This prospective multi-institutional cohort study (French CDH Registry) included CDH neonates born in France between January 1st, 2010-December 31st, 2018. Patch CDH was defined as need for synthetic patch or muscle flap repair. Main outcome measures included need for curative fundoplication, tube feed supplementation, failure to thrive, and oral aversion. RESULTS Of 762 CDH neonates included, 81 underwent fundoplication (10.6%), either preventive or curative. Median follow-up was 3.0 years (IQR: 1.0-5.0). (1) Preventive fundoplication is considered in only 31% of centers. The rates of both curative fundoplication (9% vs 3%, p = 0.01) and overall fundoplication (20% vs 3%, p < 0.0001) are higher in centers that perform preventive fundoplication compared to those that do not. (2) Predictive factors for preventive fundoplication were: prenatal diagnosis (p = 0.006), intra-thoracic liver (p = 0.005), fetal tracheal occlusion (p = 0.002), CDH-grade C-D (p < 0.0001), patch repair (p < 0.0001). After CDH repair, 8% (n = 51) required curative fundoplication (median age: 101 days), for which a patch repair was the only independent predictive factors identified upon multivariate analysis. (3) In neonates with patch CDH, preventive fundoplication did not decrease the need for curative fundoplication (15% vs 11%, p = 0.53), and was associated with higher rates of failure to thrive (discharge: 81% vs 51%, p = 0.03; 6-months: 81% vs 45%, p = 0.008), tube feeds (6-months: 50% vs 21%, p = 0.02; 2-years: 65% vs 26%, p = 0.004), and oral aversion (6-months: 67% vs 37%, p = 0.02; 1-year: 71% vs 40%, p = 0.03). CONCLUSIONS Children undergoing a CDH patch repair are at high risk of requiring a curative fundoplication. However, preventive fundoplication during a patch repair does not decrease the need for curative fundoplication and is associated with worse gastro-intestinal outcomes in children. LEVEL OF EVIDENCE II - Prospective Study.
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Affiliation(s)
- Louise Montalva
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, AP-HP, Paris, France; Sorbonne University, Paris, France.
| | - Elisabeth Carricaburu
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, AP-HP, Paris, France
| | - Rony Sfeir
- Lille University and University Hospital, Lille, France
| | - Virginie Fouquet
- Department of Pediatric Surgery, Paris South University Hospitals, AP-HP, Le Kremlin-Bicêtre, France
| | - Naziha Khen-Dunlop
- Department of Pediatric Surgery, Necker-Enfants Malades, AP-HP, Paris, France
| | - Frederic Hameury
- Department of Pediatric Surgery, Hôpital Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France
| | - Nicoleta Panait
- Department of Pediatric Surgery, La Timone Children Hospital, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, Rennes University Hospital, Rennes, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Tours University Hospital, Tours, France
| | - Françoise Schmitt
- Department of Pediatric Surgery, Angers University Hospital, Angers, France
| | - Christian Piolat
- Department of Pediatric Surgery, Couple-Enfant Hospital, Grenoble, France
| | - Frederic Lavrand
- Department of Pediatric Surgery, University of Bordeaux, Pellegrin University Hospital, Bordeaux, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Aurélien Scalabre
- Department of Pediatric Surgery, Hôpital Nord, Saint-Etienne, France
| | - Erik Hervieux
- Department of Pediatric Surgery, Armand Trousseau University Hospital, Paris, France
| | - Jean-Luc Michel
- Department of Pediatric Surgery, Felix Guyon Hospital, La Réunion, France
| | - Isabelle Germouty
- Department of Pediatric Surgery, Brest University Hospital, Brest, France
| | - Philippe Buisson
- Department of Pediatric Surgery, Amiens University Hospital, Amiens, France
| | - Frederic Elbaz
- Department of Pediatric Surgery, University Hospital, Rouen, France
| | - Jean-Francois Lecompte
- Department of Pediatric Surgery, Nice Pediatric Hospital, University of Nice-Sophia Antipolis, Nice, France
| | - Thierry Petit
- Department of Pediatric Surgery, Caen University Hospital, Caen, France
| | - Audrey Guinot
- Department of Pediatric Surgery, Hôtel-Dieu University Hospital, Nantes, France
| | - Olivier Abbo
- Department of Pediatric Surgery, Hôpital des Enfants, Toulouse, France
| | - Emmanuel Sapin
- Department of Pediatric Surgery, Dijon University Hospital, Dijon, France
| | - François Becmeur
- Department of Pediatric Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Forgues
- Department of Pediatric Surgery, Montpellier University Hospital, Montpellier, France
| | - Maguelonne Pons
- Department of Pediatric Surgery, Clermont Ferrand University Hospital, Clermont Ferrand, France
| | - Arnaud Fotso Kamdem
- Department of Pediatric Surgery, Besançon University Hospital, Besançon, France
| | - Nicolas Berte
- Department of Pediatric Surgery, University Hospital, Nancy, France
| | - Marie Auger-Hunault
- Department of Pediatric Surgery, Poitiers University Hospital, Poitiers, France
| | - Alexandra Benachi
- Université Paris-Sud, Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart, France
| | - Arnaud Bonnard
- Department of Pediatric General Surgery and Urology, Robert-Debré University Hospital, AP-HP, Paris, France
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Wong HJ, Vierra M, Hedberg M, Attaar M, Su B, Kuchta K, Chiao G, Linn JG, Haggerty SP, Ujiki MB. A Tailored Approach to Laparoscopic Fundoplication: Outcomes in Patients with Esophageal Dysmotility. J Gastrointest Surg 2022; 26:2426-2433. [PMID: 36221019 DOI: 10.1007/s11605-022-05452-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Esophageal dysmotility is a common finding in patients being evaluated for antireflux surgery, although its implication remains unclear. We aimed to evaluate outcomes of patients with esophageal dysmotility after fundoplication. METHODS A retrospective review of a prospective quality-database was performed. All patients who underwent laparoscopic Nissen (NF) or Toupet (TF) fundoplication were included. Esophageal dysmotility was defined using the Chicago Classification v4.0 and conventional metrics, creating three sub-groups: ineffective esophageal motility (IEM), distal/diffuse esophageal spasm (DES), and hypercontractile esophagus (HE). Quality of life (QOL) outcomes were measured by the Reflux Severity Index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), and Dysphagia Scores. RESULTS Of 487 patients included, 99 (20.3%) had esophageal dysmotility (49 IEM, 40 DES, 10 HE). While a majority in the dysmotility group (81.8%) underwent TF, most patients in the normal group (76.5%) underwent NF (p < 0.001). On multivariable analysis controlling for sex, age, BMI, hiatal hernia, and surgery type, the normal group had higher Dysphagia Scores at 3 weeks (2.2 ± 0.9 vs. 1.7 ± 0.8, p < 0.001), but not at 6-month, 1-year, 2-year, or 5-year follow-up. There were no differences between normal and dysmotility groups in terms of RSI or GERD-HRQL scores at any time point. Patients with different sub-types of esophageal dysmotility had similar QOL outcomes at all time points. CONCLUSION Patients with esophageal dysmotility had similar outcomes compared to those with normal motility after fundoplication, suggesting the tailored approach favoring partial fundoplication for patients with dysmotility as part of an appropriate treatment algorithm.
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Affiliation(s)
- Harry J Wong
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA. .,Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | - Mason Vierra
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Mason Hedberg
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA
| | - Mikhail Attaar
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA.,Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Bailey Su
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA.,Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA
| | - Gene Chiao
- Department of Gastroenterology, NorthShore University HealthSystem, Evanston, IL, USA
| | - John G Linn
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA
| | - Stephen P Haggerty
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave GCSI rmB665 Evanston, Evanston, IL, 60201, USA
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10
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Markar S, Andreou A, Bonavina L, Florez ID, Huo B, Kontouli K, Low DE, Mavridis D, Maynard N, Moss A, Pera M, Savarino E, Siersema P, Sifrim D, Watson DI, Zaninotto G, Antoniou SA. UEG and EAES rapid guideline: Update systematic review, network meta-analysis, CINeMA and GRADE assessment, and evidence-informed European recommendations on surgical management of GERD. United European Gastroenterol J 2022; 10:983-998. [PMID: 36196591 PMCID: PMC9731663 DOI: 10.1002/ueg2.12318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/17/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND There are several options for the surgical management of GERD in adults. Previous guidelines and systematic reviews have compared the effects of total fundoplication versus pooled effects of different techniques of partial fundoplication. OBJECTIVE To develop evidence-informed, trustworthy, pertinent recommendations on the use of total, posterior partial and anterior partial fundoplications for the management of GERD in adults. METHODS We performed an update systematic review, network meta-analysis, and evidence appraisal using the GRADE and the Confidence in Network Meta-Analysis methodologies. An international, multidisciplinary panel of surgeons, gastroenterologists, and a patient representative reached unanimous consensus through an evidence-to-decision framework to select among multiple interventions, and a Delphi process to formulate the recommendation. The project was developed in an online authoring and publication platform (MAGICapp), and was overseen by an external auditor. RESULTS We suggest posterior partial fundoplication over total posterior or anterior 90° fundoplication in adult patients with GERD. We suggest anterior >90° fundoplication as an alternative, although relevant comparative evidence is limited (weak recommendation). The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/j20X4n. CONCLUSION This rapid guideline was developed in line with highest methodological standards and provides evidence-informed recommendations on the surgical management of GERD. It provides user-friendly decision aids to inform healthcare professionals' and patients' decision making.
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Affiliation(s)
- Sheraz Markar
- Nuffield Department of SurgeryUniversity of OxfordOxfordUK
- Department of Molecular Medicine and SurgeryKarolinska InstituteStockholmSweden
| | | | - Luigi Bonavina
- Department of Biomedical Sciences for HealthDivision of General and Foregut SurgeryIRCCS Policlinico San DonatoUniversity of MilanMilanItaly
| | - Ivan D. Florez
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
- Department of PediatricsUniversity of AntioquiaMedellinColombia
| | - Bright Huo
- Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Donald E. Low
- Department of Thoracic Surgery and Surgical OncologyVirginia Mason Medical CenterSeattleWashingtonUSA
| | - Dimitris Mavridis
- Department of Primary EducationSchool of Education University of IoanninaIoanninaGreece
- Paris Descartes UniversitySorbonne Paris CitéFaculté de MédecineParisFrance
| | - Nick Maynard
- Nuffield Department of SurgeryUniversity of OxfordOxfordUK
| | | | - Manuel Pera
- Gastroesophageal Carcinogenesis Research GroupHospital del Mar Medical Research Institute (IMIM)BarcelonaSpain
- Section of Gastrointestinal SurgeryHospital Universitario del MarUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Edoardo Savarino
- Department of Surgery, Oncology and GastroenterologyGastroenterology UnitUniversity of PaduaPaduaItaly
| | - Peter Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Daniel Sifrim
- Wingate Institute of NeurogastroenterologyBlizard InstituteBarts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - David I. Watson
- Flinders University Discipline of SurgeryFlinders Medical CentreBedford ParkSouth AustraliaAustralia
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11
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Skerritt C, Kwok CS, Kubiak R, Rees CM, Grant HW. 10 Year Follow-Up of Randomized Trial of Laparoscopic Nissen Versus Thal Fundoplication in Children. J Laparoendosc Adv Surg Tech A 2022; 32:1183-1189. [PMID: 36126310 DOI: 10.1089/lap.2022.0083] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The aim of this study was to compare the long-term outcomes of laparoscopic complete (Nissen) fundoplication (LNF) with laparoscopic partial (Thal) fundoplication (LTF) in children. This is the only prospective, randomized study to follow patients up for more than 10 years. Interim results published in 2011 at median 2.5 year follow-up showed that LNF had a significantly lower failure rate compared with LTF. Materials and Methods: A randomized, controlled trial of LNF versus LTF in children (<16 years) was performed. The primary outcome measure was "absolute" failure of the fundoplication-recurrence of symptoms that merited either reoperation or insertion of transgastric jejunostomy (GJ). Secondary outcomes were "relative" failure (need for postop antireflux medication), complications (e.g., dysphagia), and death. Results: One hundred seventy-five patients were recruited; 89 underwent LNF, and 86 underwent LTF. Eight patients had no follow-up recorded. At long-term follow-up, 59 patients had died (35%); LNF 37/85 (43.5%) and LTF 22/82 (26.8%), P = .02. Median length of follow-up in survivors was 132 months. There was no statistically significant difference in "absolute" failure rate between LNF 8/85(9.4%) and LTF 15/82 (18%), P = .14. There was no difference in "relative" failure between LNF 7/85 (8.2%) and LTF 12/82 (14%), P = .23. Long-term dysphagia affected 5 out of 108 (4.6%) patients; 3/48 (6.2%) of LNF and 2/60 (3.3%) of LTF (P = .65). Conclusions: There was no statistically significant difference in 'absolute' failure between LNF and LTF at long-term follow-up. Neurologically impaired children have a high mortality rate following fundoplication due to comorbidities. This trial commenced in 1998 and was approved by the Oxfordshire Research Ethics Committee (No. 04.OXA.18-1998).
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Affiliation(s)
- Clare Skerritt
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford Radcliffe NHS Trusts, Oxford, United Kingdom.,Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Chun-Sui Kwok
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford Radcliffe NHS Trusts, Oxford, United Kingdom
| | - Rainer Kubiak
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford Radcliffe NHS Trusts, Oxford, United Kingdom.,Department of Paediatric Surgery, University Medical Centre Mannheim, Mannheim, Baden-Wurttemberg, Germany
| | - Clare M Rees
- Department of Paediatric Surgery, Imperial College Healthcare NHS Trust, United Kingdom
| | - Hugh W Grant
- Department of Paediatric Surgery, Oxford Children's Hospital, Oxford Radcliffe NHS Trusts, Oxford, United Kingdom
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12
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Callahan ZM, Amundson J, Su B, Kuchta K, Ujiki M. Outcomes after anti-reflux procedures: Nissen, Toupet, magnetic sphincter augmentation or anti-reflux mucosectomy? Surg Endosc 2022; 37:3944-3951. [PMID: 35999311 DOI: 10.1007/s00464-022-09544-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/07/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Surgical treatment options of gastroesophageal reflux disease have changed significantly in the last 50 years. Magnetic Sphincter Augmentation (MSA) and Anti-reflux Mucosectomy (ARMs) are gaining traction but there is a paucity of literature comparing these novel options to Toupet fundoplication and gold standard Nissen fundoplication. METHODS This is a retrospective review of a prospectively maintained database, evaluating patients undergoing Nissen, Toupet, MSA, and ARMs. Pre-operative, intra-operative, and post-operative variables including Reflux symptom index (RSI), Gastroesophageal Reflux Disease-Health Related Quality of Life questionnaire (GERD-HRQL), and Dysphagia scores were compared between groups. RESULTS During the study period, 649 patients underwent anti-reflux surgery. Patients who underwent Nissen or Toupet were younger than those undergoing MSA or ARMs (65 ± 12 and 67 ± 14 years vs 56 ± 14 and 56 ± 18 years, P < 0.01). Average operative time for Nissen was 127 ± 40 min which was similar to a Toupet at 122 ± 32 min. These durations were significantly longer than for MSA, averaging 79 ± 29, and ARMs, at a mean 35 ± 3 min (all P < 0.001). Length of stay was significantly different among all four groups with Nissen, Toupet, MSA, and ARMs patients staying a median of 31, 24, 7, and 3 h post operatively, respectively (all P < 0.001). Complications and re-admissions were similarly low among all groups. Despite minor differences in RSI and GERD-HRQL scores at isolated follow-up time points, quality of life scores seems to be similar overall at up to 5 years follow-up. Gas bloat and dysphagia did not differ among groups at any time point. CONCLUSIONS Novel anti-reflux surgery options provide similar GERD-related quality of life compared to traditional full or partial fundoplications with the added benefit of shorter operative time and faster recovery.
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Affiliation(s)
- Zachary M Callahan
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Julia Amundson
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Bailey Su
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Michael Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
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13
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Wu H, Attaar M, Wong HJ, Campbell M, Kuchta K, Denham W, Linn J, Ujiki MB. Impedance planimetry (EndoFLIP™) after magnetic sphincter augmentation (LINX®) compared to fundoplication. Surg Endosc 2022; 36:7709-7716. [PMID: 35169878 DOI: 10.1007/s00464-022-09128-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Functional luminal imaging probe (FLIP) use during laparoscopic fundoplication (LF) for gastroesophageal reflux disease is well described. However, there is a lack of data on FLIP measurements during magnetic sphincter augmentation (MSA). This study aims to report our institutional experience in performing FLIP during MSA and to compare these measurements to those obtained during Nissen and Toupet fundoplication. METHODS AND PROCEDURES A retrospective review of a prospectively maintained quality database was performed. Patients who underwent MSA or LF and had FLIP measurements between April 2018 and June 2021 were included. FLIP measurements at the gastroesophageal junction (GEJ) were recorded without pneumoperitoneum at 40 mL balloon fill after hernia reduction, cruroplasty, and MSA or fundoplication. Reflux symptom index (RSI), GERD-HRQL, and dysphagia score were collected up to 2 years. Group comparisons were made using two-tailed Wilcoxon rank-sum and χ2 tests, with statistical significance of p < 0.05. RESULTS Twenty-seven patients underwent MSA and 100 patients underwent LF (66% Toupet, 34% Nissen). Type III hiatal hernia was present in 3.7% of MSA patients versus over 50% for fundoplication patients. Minimum diameter, cross-sectional area, and distensibility index (DI) were lower after MSA device placement compared to Nissen or Toupet fundoplication (p < 0.05). Postoperative follow-up showed no differences in RSI, GERD-HRQL, and dysphagia score between MSA and Nissen fundoplication (p > 0.05). CONCLUSION Intraoperative impedance planimetry provided objective information regarding the geometry of the GEJ during MSA. The ring of magnetic beads restores the anti-reflux barrier and transiently opens with food bolus and belching. The magnetic force of the beads may explain why the DI after MSA is lower yet postoperative quality of life is no different than Nissen fundoplication.
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Affiliation(s)
- Hoover Wu
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA. .,Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA. .,Department of Surgery, NorthShore University Health System, 2650 Ridge Ave, GCSI Suite B665, Evanston, IL, 60201, USA.
| | - Mikhail Attaar
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA.,Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Harry J Wong
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA.,Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Michelle Campbell
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA.,Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Woody Denham
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - John Linn
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
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14
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Abstract
Approximately, 10% to 15% of patients in the United States experience gastroesophageal reflux symptoms on a weekly basis, negatively affecting the quality of life and increasing the risk of reflux-related complications. For patients with symptoms recalcitrant to proton pump inhibitor (PPI) therapy or those who cannot take PPIs, surgical fundoplication is the gold standard. The preoperative workup is complex but vital for operative planning and ensuring good postoperative outcomes. Most patients are highly satisfied after fundoplication, though transient dysphagia, gas bloating, and resumption of PPI use are common postoperatively. Multiple newer technologies offer safe alternatives to fundoplication with similar outcomes.
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Affiliation(s)
- Christopher J Zimmermann
- Department of Surgery, University of Wisconsin- Madison, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375, USA
| | - Anne Lidor
- Department of Surgery, University of Wisconsin- Madison, Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-7375, USA.
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15
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Jacobson JC, Pandya SR. A narrative review of gastroesophageal reflux in the pediatric patient. Transl Gastroenterol Hepatol 2021; 6:34. [PMID: 34423155 DOI: 10.21037/tgh-20-245] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/12/2020] [Indexed: 11/06/2022] Open
Abstract
Gastroesophageal reflux (GER) is the retrograde passage of gastric contents into the esophagus. It is a physiologic condition that is common in neonates, typically resolves spontaneously, and does not result in clinically significant complications. When pathologic, gastroesophageal reflux disease (GERD) can cause numerous complications including persistent emesis, failure to thrive, aspiration, and respiratory symptoms. While a diagnosis can often be made from a thorough history and physical, some patients may require further testing. In general, many clinicians will reserve extensive investigation such as multiple intraluminal impedance and pH monitoring for patients with a confounding clinical picture or relative contraindications to medical or surgical management. Whereas most pediatric GER resolves spontaneously, medical management including lifestyle changes, changes to feeds, and the use of H2-antagonists and/or proton pump inhibitors (PPIs) can be utilized to alleviate symptoms. Surgical treatment is reserved for patients who are refractory to medical management or have suffered significant complications as a consequence of GER. In this article we seek to provide a concise but detailed review of recent updates in the understanding, work up and management of GER in the pediatric patient. A summary of new technologies used in the diagnostic and therapeutic arms of this disease are included.
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Affiliation(s)
| | - Samir R Pandya
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Children's Medical Center, Dallas, TX, USA
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16
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Till H, Esposito C, Escolino M, Singer G, Gasparella P, Arneitz C. Laparoscopic Treatment of Gastroesophageal Reflux Disease in Children: How We Do It. J Laparoendosc Adv Surg Tech A 2021; 31:1175-1179. [PMID: 34415797 DOI: 10.1089/lap.2021.0401] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Over decades now, laparoscopic Nissen fundoplication represents the treatment of choice for symptomatic children with gastroesophageal reflux disease (GERD) unresponsive to medication. Although the basic principles of Nissen's technique are still essential today, academic studies of long-term results, complications, and patients benefits have fostered distinct modifications. Identification of surgical factors for wrap migration, dysphagia, and recurrent GERD led to recommendations for "short and floppy" wraps with minimal dissection of the phrenoesophageal membranes. This report summarizes up-to-date information from experts in the field on "how to wrap it right" followed by a critical discussion about long-term benefits for children with GERD and future developments of laparoscopic Nissen fundoplication.
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Affiliation(s)
- Holger Till
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Ciro Esposito
- Pediatric Surgical Unit, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- Pediatric Surgical Unit, Federico II University of Naples, Naples, Italy
| | - Georg Singer
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
| | - Christoph Arneitz
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria
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17
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Carandina S, Zulian V, Nedelcu A, Danan M, Vilallonga R, Nocca D, Nedelcu M. Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature. ACTA ACUST UNITED AC 2021; 57:medicina57040392. [PMID: 33919520 PMCID: PMC8073310 DOI: 10.3390/medicina57040392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/11/2021] [Accepted: 04/16/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: The rising numbers of laparoscopic sleeve gastrectomy (LSG) procedures now being performed worldwide will likely be followed by an increasing number of patients experiencing gastro-esophageal reflux disease (GERD). The purpose of the current review was to analyze in terms of safety different techniques of fundoplication used to treat GERD associated with LSG. Methods: An online search was performed in PubMed/MEDLINE in December 2020 to identify articles reporting LSG and fundoplication. The following term combination was used: (sleeve, fundoplication), (sleeve, Nissen), (sleeve, Rossetti), (sleeve, Toupet) and (sleeve, Dor). The extracted information included details of the methods (e.g., retrospective case series), demographic characteristics (e.g., age, gender), clinical characteristics, number of patients, rate of conversion, and postoperative outcomes. Results: A total of 154 studies were identified and after an assessment of title according to our exclusion criteria, 116 articles were removed. Of the 38 studies analyzed for full content review, a total of seven primary studies (487 patients) were identified with all inclusion criteria. Analyzing the different types of fundoplication used, we have identified: 236 cases of Nissen-Sleeve, 220 cases with modified Rossetti fundoplication, 31 cases of Dor fundoplication, and no case of Toupet fundoplication. The overall postoperative complication rate was 9.4%, with the most common reported complication being gastric perforation, 15 cases-3.1%. The second most common complication was bleeding identified in nine cases (1.8%) followed by gastric stenosis in six cases (1.2%). The mortality was nil. Conclusions: Different types of fundoplication associated with LSG appear to be a safe surgical technique with an acceptable early postoperative complication rate. Any type of fundoplication associated with LSG to decrease GERD should be evaluated cautiously while prospective clinical randomized trials are needed.
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Affiliation(s)
- Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
- Clinica Madonna della Salute, Department of Digestive and Bariatric Surgery, 45014 Porto Viro, Italy
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
| | - Marc Danan
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d’Hebron, 08023 Barcelona, Spain;
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08023 Barcelona, Spain
| | - David Nocca
- CHU de Montpellier, 34080 Montpellier, France;
- University Montpellier 1, 34080 Montpellier, France
| | - Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Obésité (CCO), 83100 Toulon, France; (S.C.); (V.Z.); (A.N.); (M.D.)
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- Correspondence: ; Tel.: +33-695950965
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18
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Parker B, Beard K, Fletcher R, Sharata A, Muller D, Haisley K, Reavis K, Davila Bradley D, DeMeester S, Swanström L, Dunst C. Can We Identify Patients Appropriate for Same-Day Discharge After Laparoscopic Fundoplication? J Laparoendosc Adv Surg Tech A 2021; 32:132-136. [PMID: 33797982 DOI: 10.1089/lap.2020.0929] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients, surgeons, and payers are interested in reducing hospital length of stay. Outpatient laparoscopic fundoplication (LF) can be done safely and cost effectively. There is low acceptance of this practice due to fear of readmission and patient dissatisfaction. Our aim was to identify factors predicting failure of same-day discharge after LF. Methods and Procedures: We simulated an outpatient setting for patients who underwent LF from 2017 to 2018 and collected the data prospectively. A perioperative pain and nausea protocol was utilized. Postoperatively, patients were given a liquid diet and oral medications, observed overnight, and then discharged after standard criteria were met. Failure was defined by the need for physician intervention after 3 hours or failure to discharge. Univariate and multivariable logistic regression analyses were performed assessing factors associated with failure. Two-sample t-test and chi-squared tests were used for significance. Results: Ninety-eight patients were included. Twenty patients failed, primarily due to the need for intravenous medications. Seven were discharged on postoperative day 1 but required physician intervention after 3 hours. Thirteen patients stayed >23 hours. Two patients were readmitted within 1 week of discharge. There was one acute recurrence, requiring reoperation, and one conversion to laparotomy. We found no statistically significant patient risk factor, comorbidity, or perioperative variable that could reliably predict failure of same-day discharge. Conclusion: This study suggests that same-day discharge after LF is safe and feasible. However, 20% of patients will unpredictably fail to meet discharge criteria.
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Affiliation(s)
- Brett Parker
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA.,Division of Minimally Invasive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin Beard
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Reid Fletcher
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Ahmed Sharata
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Dolores Muller
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Kelly Haisley
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Kevin Reavis
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Daniel Davila Bradley
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Steven DeMeester
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Lee Swanström
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Christy Dunst
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
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Yanes M, Santoni G, Maret-Ouda J, Ness-Jensen E, Färkkilä M, Lynge E, Nwaru B, Pukkala E, Romundstad P, Tryggvadóttir L, von Euler-Chelpin M, Lagergren J. Antireflux surgery and risk of lung cancer by histological type in a multinational cohort study. Eur J Cancer 2020; 138:80-8. [PMID: 32877797 DOI: 10.1016/j.ejca.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/04/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Airway micro-aspiration might contribute to the proposed associations between gastroesophageal reflux disease (GERD) and some lung diseases, including lung cancer. This study aimed to examine the hypothesis that antireflux surgery decreases the risk of small cell carcinoma, squamous cell carcinoma and adenocarcinoma of the lung differently depending on their location in relation to micro-aspiration. METHODS Population-based cohort study including patients having undergone antireflux surgery during 1980-2014 in Denmark, Finland, Iceland, Norway or Sweden. Patients having undergone antireflux surgery were compared with two groups: 1) the corresponding background population, by calculating standardised incidence ratios (SIRs) with 95% confidence intervals (CIs) and 2) non-operated GERD-patients, by calculating hazard ratios (HRs) with 95% CIs using multivariable Cox regression with adjustment for sex, age, calendar period, country, chronic obstructive pulmonary disease and obesity diagnosis or type 2 diabetes. RESULTS Among all 812,617 GERD-patients, 46,996 (5.8%) had undergone antireflux surgery. The SIRs were statistically significantly decreased for small cell carcinoma (SIR = 0.57, 95% CI 0.41-0.77) and squamous cell carcinoma (SIR = 0.75, 95% CI 0.60-0.92), but not for adenocarcinoma of the lung (SIR = 0.90, 95% CI 0.76-1.06). The HRs were also below unity for small cell carcinoma (HR = 0.63, 95% CI 0.44-0.90) and squamous cell carcinoma (HR = 0.80, 95% CI 0.62-1.03), but not for adenocarcinoma of the lung (HR = 1.03, 95% CI 0.84-1.26). Analyses restricted to patients with objective GERD (reflux oesophagitis or Barrett's oesophagus) showed similar results. CONCLUSIONS This all-Nordic study indicates that patients who undergo antireflux surgery are at decreased risk of small cell carcinoma and squamous cell carcinoma of the lung, but not of adenocarcinoma of the lung.
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Hannon JD, Warner LL, Stewart TM, Kor TM, Blackmon SH, Brown MJ, Subramanian A. Antinausea Protocol Reduces Hospital Length of Stay for Laparoscopic Nissen Fundoplication. J Cardiothorac Vasc Anesth 2020; 34:1853-1857. [PMID: 32234276 DOI: 10.1053/j.jvca.2020.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The perioperative course of patients undergoing laparoscopic Nissen fundoplication (LNF) was reviewed to determine whether the use of a new treatment protocol consisting of total intravenous anesthesia (TIVA) plus triple antiemetic therapy was associated with shorter hospital length of stay (HLOS). DESIGN Retrospective cohort. SETTING Single academic center. PARTICIPANTS The study comprised 448 patients. Fifty-four patients undergoing LNF who received TIVA were compared with 394 who received standard inhalational anesthesia (non-TIVA) between January 2010 and June 2017. INTERVENTIONS Patients who received TIVA were compared with those who received non-TIVA. MEASUREMENTS AND MAIN RESULTS In multivariate analysis, TIVA was significantly associated with reduced HLOS (odds ratio 2.91, 95% confidence interval 1.47-5.78) and a 7.8% reduction in cost of care (p < 0.01). Female sex, length of surgery, and older age all were negatively associated with length of stay. The association between the use of TIVA and reduced HLOS and institutional cost was compared using univariate and multivariate analyses. CONCLUSIONS The use of TIVA in patients undergoing uncomplicated LNF shortens HLOS and is associated with reduced cost of care. This study illustrates that communication among surgeons and anesthesiologists results in improved patient care.
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Affiliation(s)
- James D Hannon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Lindsay L Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Thomas M Stewart
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Todd M Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | | | - Michael J Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Arun Subramanian
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Kanani Z, Gould JC. Laparoscopic fundoplication for refractory GERD: a procedure worth repeating if needed. Surg Endosc 2020; 35:298-302. [PMID: 32016514 DOI: 10.1007/s00464-020-07396-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic fundoplication is the current gold standard for medically refractory gastroesophageal reflux disease. Over a 10-year period following surgery, 5-10% of primary laparoscopic fundoplication patients undergo reoperative surgery. Our objective was to compare the symptomatic outcomes and morbidity of primary and reoperative fundoplication procedures. METHODS This was a retrospective review of patients who underwent laparoscopic primary or reoperative fundoplication between 2011 and 2017. A single surgeon with a more than 10-year experience in reoperative foregut surgery performed all procedures. Patients in both groups completed the GERD health-related quality of life (GERD-HRQL) survey prior to surgery and postoperatively. Outcomes were reflected by the composite GERD-HRQL scores (0 to 50, with lower scores representing a better GERD-related quality of life), which were compared between groups postoperatively. Demographics, perioperative data, and complications were compared. Patient data were analyzed using Chi-Square tests and outcomes were analyzed using independent samples t tests and Mann-Whitney U tests. RESULTS There were 136 primary and 82 reoperative fundoplications. Prior to surgery, GERD-HRQL scores were similar for primary and reoperative patients. Both groups experienced significant improvement in GERD-related quality of life at 2 years, although this improvement was greater in primary patients (8.7 ± 7.8 primary vs. 14.3 ± 13.6 reoperative, p = 0.02). Operative time and length of stay were longer following reoperative cases. The rate of moderate to severe 30-day complications requiring radiologic, endoscopic, or surgical intervention was similar (2.9% primary vs. 1.2% reoperative, p = 0.65). CONCLUSIONS Patients who undergo reoperative fundoplication experience a significant improvement in their GERD-related symptoms, although not to the degree seen in primary antireflux surgery patients. Perioperative morbidity rates following reoperative and primary procedures can be similar in the hands of an experienced surgeon.
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Affiliation(s)
- Zia Kanani
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Jon C Gould
- Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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Abstract
Several techniques are available for a gastrostomy concomitant with a major abdominal surgery, i.e., there is no 'standard' technique. Here, we present our results of a novel concomitant gastrostomy developed for the Nissen fundoplication. It combines the laparoscopic instrumentation with the kit for percutaneous endoscopic gastrostomy. Once the fundoplication is completed, the gastrostomy is performed in three stages. First, with the orogastric tube and snare, the loop of wire is left in the peritoneal cavity; next, a guide-wire introduced into the peritoneal cavity from the abdominal wall, is taken with the loop, and retrieved at the mouth; finally, the gastrostomy tube is pulled with the guide-wire from mouth to abdominal wall. Only laparoscopic instrumentation is used to choose the site in the stomach, and to perform the puncture; hence, the gastroscope is unnecessary. By choosing the proper sites, stomata are aligned and free of lateral strains making the gentle pressure of the dome enough to appose gastric and abdominal walls; hence, stitches become unnecessary to affix the walls. This percutaneous laparoscopic gastrostomy is simple, brief (ca 21 min), well tolerated, without complications during the intervention or the postoperatory period, reproducible, and of low cost, and exceptional skills are not required. Finally, laparoscopic protocols for a primary gastrostomy may dispel some complications by choosing a 'pull' to install the gastrostomy tube as reported here, instead of the usual 'push'.
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Affiliation(s)
- Francisco Saitua
- Hospital Luis Calvo Mackenna, Santiago, Chile; Universidad de Chile, Santiago, Chile; Clínica Alemana de Santiago, Chile.
| | - Alvaro Weibel
- Hospital Luis Calvo Mackenna, Santiago, Chile; Clínica Alemana de Santiago, Chile
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Holcomb CN, Switzer NJ, Jalilvand A, Belle P, McNally M, Perry K. Impact of psychiatric disorders on patient satisfaction after Nissen Fundoplication. Surg Endosc 2020; 34:1829-34. [PMID: 31410627 DOI: 10.1007/s00464-019-06949-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anxiety and depression have been associated with an increased perception of gastroesophageal reflux symptoms, but there is a paucity of data regarding the outcomes of laparoscopic Nissen Fundoplication (LNF) in this patient population. METHODS We performed a retrospective cohort study including all patients undergoing LNF between 2011 and 2017. Patients were stratified by baseline usage of serotonin-modulating medication or benzodiazepines as a proxy for depression and anxiety, respectively. Outcome measures included postoperative gastroesophageal health-related quality of life (GERD-HRQL) scores and overall satisfaction rates after surgery. A p value of < 0.05 was considered statistically significant. RESULTS The population consisted of 271 patients of which 103 patients had depression and 44 patients had anxiety. Patients with depression reported no significant difference in pre- or postoperative GERD-HRQL scores compared to patients without depression and long-term satisfaction rates after surgery were similar in both groups at 76% vs 71%, respectively (p = 0.55). Patients with anxiety reported higher baseline HRQL scores (34 vs. 29, p = 0.05). At long-term follow-up (15 months), patients with anxiety reported slightly worse HRQL scores compared to controls (7 vs. 4, p = 0.11) despite no difference in usage of anti-acid medications or need for endoscopic dilations between the two groups. Patients with anxiety were less likely to report being "satisfied" after surgery (40% vs. 71%, p = 0.01) compared to controls. CONCLUSION Patients with anxiety have higher subjective reporting of GERD symptoms and are more likely to report being "satisfied" during long-term follow-up after LNF. Patients on medication for depression appear to have similar reporting of GERD symptoms and derive as much benefit from LNF as patients that are not. While LNF does improve the symptom burden in patients with anxiety, satisfaction is rarely achieved in long-term follow-up.
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Milford K, Numanoglu A, Sultan TA, Klopper J, Cox S. Predictors of multiple readmissions or death in the first year after Nissen fundoplication in children. Pediatr Surg Int 2019; 35:501-7. [PMID: 30560416 DOI: 10.1007/s00383-018-04429-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Nissen fundoplication (NF) is commonly performed in children with gastro-esophageal reflux disease (GERD). Patients undergoing NF often have co-morbidities. Reported outcomes of NF vary considerably. This study investigated which factors might predict multiple readmissions or death in the first year following NF at our institution. METHODS A retrospective chart review of 187 children who underwent NF at our institution between January 2004 and December 2015 was undertaken. Underlying medical conditions, age, weight, presence of malnutrition, length of hospital stay prior to surgery and type of surgery were recorded. Patients who had more than one admission in the first post-operative year were compared to those who had one or none, and patients who died within the first post-operative year were compared to those who did not. RESULTS Risk factors for multiple readmissions were underlying cardiac disease (p = 0.011), esophageal atresia (EA) (p = 0.011), and esophageal stricture (p = 0.0002). Risk factors for death included younger age (p = 0.028), need for gastrostomy tube (GT) (p = 0.01) and prolonged pre-operative hospital admission (p = 0.0003). CONCLUSION This study identified multiple factors associated with readmission and death in the first year after NF. These findings will help with the counseling patients and caregivers regarding expectations following NF.
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Perivoliotis K, Sarakatsianou C, Tepetes K, Baloyiannis I. Single incision laparoscopic fundoplication: A systematic review of the literature. World J Gastrointest Surg 2019; 11:179-190. [PMID: 31057702 PMCID: PMC6478600 DOI: 10.4240/wjgs.v11.i3.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fundoplication, was first introduced as a surgical treatment method of gastroesophageal reflux disease. Consequently, several modifications of this method have been described, whereas laparoscopic fundoplication was recently introduced. Although single incision (SI) fundoplication was considered as an alternative to the conventional laparoscopic approach, several studies reported an increased operation duration, and high rates of multiport conversion and incisional hernia.
AIM To provide a current overview of the technical variations and the postoperative outcomes of patients submitted to SI fundoplication.
METHODS The present systematic review of the literature was designed and conducted on the basis of the PRISMA guidelines. A systematic screening of the electronic scholar databases (Medline, Scopus and Web of Science) was performed.
RESULTS Literature search resulted in the identification of 19 studies. Overall, 266, 137 and 110 SI Nissen, Dor and Toupet fundoplications were reported, respectively. In the majority of the trials, standard laparoscopic instruments were used. The left liver lobe was displayed through the use of forceps, graspers, retractors, drains or even glue. Both intra-corporeal and extracorporeal suturing was described. Mean operative time was 136.3 min. Overall complication rate was 5.2% and the rate of incisional hernia was 0.9%. No mortality was reported.
CONCLUSION Due to the methodological heterogeneity and the lack of high quality studies comparing multi to single access techniques and the several variations, we conclude that further well designed studies are necessary, in order to evaluate the role of SI fundoplication.
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Affiliation(s)
| | | | | | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
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26
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Rosales A, Whitehouse J, Laituri C, Herbello G, Long J. Outcomes of laparoscopic nissen fundoplications in children younger than 2-years: single institution experience. Pediatr Surg Int 2018; 34:749-754. [PMID: 29808280 DOI: 10.1007/s00383-018-4281-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Variation exists in the diagnostic testing for gastroesophageal reflux (GER) in infants and in the application of surgical therapy. There has been an increase in antireflux surgery (ARS) since the development of laparoscopy but the outcomes in high-risk infants is unclear. This study examines the results of laparoscopic fundoplication in infants less than 2 years. METHODS The results of infants less than 2 years undergoing laparoscopic Nissen fundoplication (Lap-F) from 2012 to 2015 were retrospectively reviewed and outcomes were followed until 2017. RESULTS There were 106 patients, median gestational age 32.50 weeks ± 6.35 SD and non-corrected age at operation 23.0 weeks ± 19.0 SD, mean weight of 4.81 kg ± 2.10 SD. One of the most common reasons for surgical consultation was improvement in respiratory status after insertion of nasoduodenal feeding tube. Of the Lap-F, 100 were with gastrostomy tube (GT). There were no conversions to open or intraoperative complications. The complication rate was 4.71%, and the reoperation rate was 5.66%, one fundoplication revision and the others gastrostomy revisions. The median time for feeds and to reach goal were 1 (1-14) and 4 (2-279) days, respectively. The 30-day mortality was 0.9% and long-term it was 4.71%. The long-term mortality was related to the underlying medical problems. The median follow-up was 113 (3-286) weeks. One patient required revision of the fundoplication and none required esophageal dilatation during the follow-up period. CONCLUSION Fundoplication is effective for relief of symptoms of GER in children younger than 2 years. The procedure has a low morbidity and mortality in this population.
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Affiliation(s)
- Armando Rosales
- Department of Surgery, Cleveland Clinic Florida, Weston, USA
| | - Jill Whitehouse
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Carrie Laituri
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Glenda Herbello
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Julie Long
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA.
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Castelijns PSS, van de Poll MCG, Smulders JF. A Modified Technique to Create a Standardized Floppy Nissen Fundoplication Without a Bougie. J Laparoendosc Adv Surg Tech A 2018; 28:853-858. [PMID: 29466120 DOI: 10.1089/lap.2017.0734] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Nissen fundoplication is frequently applied in the surgical treatment of patients with gastroesophageal reflux disease (GERD). When the gastroesophageal junction remains too large or becomes too narrow, persistent GERD or dysphagia may occur. To assure a correct size of the gastroesophageal junction, the fundoplication can be created over a bougie. However, this increases the risk of esophageal perforation. Therefore, we have modified a previously described technique to create a standardized fundoplication without the use of a bougie. In this article, we describe this technique and demonstrate the initial results. MATERIALS AND METHODS We describe a technique to create a standardized Nissen fundoplication. After suture repair of the hiatal hernia, three marking sutures were placed on the gastric fundus, based on an equilateral triangle. The size of this triangle determines the final diameter of the fundoplication. With these measurements, we assure sufficient patency, minimize rotation, and create a more reproducible fundoplication that may reduce postoperative dysphagia. RESULTS We have operated 15 patients according to this technique. Mean operative time was 69.5 (SD 8.4) minutes, no complications occurred. There was no early dysphagia and the mean length of stay was 1.3 days (1-2). Quality of life after 1 year was excellent. CONCLUSIONS This modified method for standardized Nissen fundoplication is safe and might reduce postoperative dysphagia. Quality of life after 1 year is excellent. The effect on postoperative dysphagia and the reproducibility of this technique should be established in a large prospective study.
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Affiliation(s)
- Petrus S S Castelijns
- 1 Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands
| | - Marcel C G van de Poll
- 1 Department of Surgery, Maastricht University Medical Centre , Maastricht, The Netherlands .,2 Department of Intensive Care Medicine, Maastricht University Medical Centre , Maastricht, The Netherlands .,3 School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University , Maastricht, The Netherlands
| | - Johannes F Smulders
- 4 Department of Surgery, Catharina Hospital Eindhoven , Eindhoven, The Netherlands
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Esposito C, Saxena A, Irtan S, Till H, Escolino M. Laparoscopic Nissen Fundoplication: An Excellent Treatment of GERD-Related Respiratory Symptoms in Children-Results of a Multicentric Study. J Laparoendosc Adv Surg Tech A 2018; 28:1023-1028. [PMID: 29466083 DOI: 10.1089/lap.2017.0631] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Respiratory manifestations of gastroesophageal reflux disease (GERD), particularly chronic cough, are being recognized with increased frequency in children. This survey aimed to investigate the efficacy of laparoscopic Nissen fundoplication for treatment of GERD-related respiratory symptoms not responsive to medical therapy in neurological normal children. MATERIALS AND METHODS We collected data of children with GERD-related respiratory complaints not responsive to medical therapy who underwent laparoscopic Nissen fundoplication in four European centers of Pediatric Surgery over a 10-year period. We excluded children with neurological impairment. RESULTS A total of 220 laparoscopic Nissen procedures were performed in the period 2005-2015. Twenty-four (12 boys and 12 girls, average age 9.5 years) out of the 220 patients (10.9%) presented with chronic cough and other respiratory manifestations, including asthma, reactive airway disease, and recurrent pneumonia. Average operative time was 65 minutes (range 45-100). As for postoperative complications, two tight wraps requiring endoscopic dilatation (IIIb Clavien) and two relapses of GERD for slipped Nissen requiring reoperation (IIIb Clavien) were recorded. None of these complications occurred in the group of patients with GERD-related respiratory symptoms. At follow-up evaluation, respiratory symptoms disappeared with a significant improvement of quality of life scoring (I Grade Visick) in 22/24 patients (91.6%). CONCLUSION Our results confirm that GERD should be investigated as one of the possible etiologic factors in any child with persistent respiratory complaints. In patients with symptoms not responsive to medical therapy, laparoscopic Nissen fundoplication is the treatment of choice with a very high success rate (>90% in our series), a very low morbidity, a significant improvement in airway symptoms, and a marked reduction in the need for medications.
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Affiliation(s)
- Ciro Esposito
- 1 Division of Pediatric Surgery, Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy
| | - Amulya Saxena
- 2 Division of Pediatric Surgery, Chelsea Children's Hospital , London, United Kingdom
| | - Sabine Irtan
- 3 Division of Pediatric Surgery, Hôpital Armand Trousseau , Paris, France
| | - Holger Till
- 4 Division of Pediatric Surgery, Medical University of Graz , Graz, Austria
| | - Maria Escolino
- 1 Division of Pediatric Surgery, Department of Translational Medical Sciences, Federico II University of Naples , Naples, Italy
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Castelijns PSS, Ponten JEH, Vd Poll MCG, Bouvy ND, Smulders JF. Quality of life after Nissen fundoplication in patients with gastroesophageal reflux disease: Comparison between long- and short-term follow-up. J Minim Access Surg 2018; 14:213-220. [PMID: 28928332 PMCID: PMC6001306 DOI: 10.4103/jmas.jmas_75_17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Nissen fundoplication is the golden standard for surgical treatment of gastroesophageal reflux disease (GERD). Numerous studies report excellent short-term results. However, data regarding long-term quality of life are lacking. The aim of this study is to investigate the long-term quality of life after Nissen fundoplication in patients with GERD and to compare this with the short-term results. Patients and Methods: We retrospectively analysed all patients who underwent laparoscopic Nissen fundoplication for GERD between January 2004 and January 2016. All patients received a validated GERD-Health-Related Quality of Life questionnaire by mail to assess post-operative quality of life. Maximum quality of life is represented by a score of 75. Secondary outcome measures were complications and recurrence rate. Results: One hundred and seventy-five (77.1%) of the 227 operated patients returned the questionnaire. The median follow-up was 3.7 (0.1–10.3) years. Mean age was 51.6 (range 15–85) and 72 patients were male. We report an excellent quality of life with a median total score of 70 (range 2–75). Re-operation rate was 13.6% (23/169); the re-operation was due to recurrent reflux in 12 patients and due to persistent dysphagia in 11 patients. 91.3% of the re-operations were performed within the first 5 years after surgery. Mortality rate was zero. Conclusion: We report a large series of single-centre, single-surgeon laparoscopic Nissen fundoplication. Despite the re-operation rate of 13.6%, we found excellent long-term symptomatic outcome. There was no difference between short- and long-term results.
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Affiliation(s)
- P S S Castelijns
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - J E H Ponten
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - M C G Vd Poll
- Department of Surgery, MUMC+; Department of Intensive Care, 6229 HX Maastricht, The Netherlands
| | - N D Bouvy
- Department of Surgery, MUMC+, 6229 HX Maastricht, The Netherlands
| | - J F Smulders
- Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
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Kapadia S, Osler T, Lee A, Borrazzo E. The role of preoperative high resolution manometry in predicting dysphagia after laparoscopic Nissen fundoplication. Surg Endosc 2017; 32:2365-2372. [PMID: 29234939 DOI: 10.1007/s00464-017-5932-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/09/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Laparoscopic fundoplication is an accepted surgical management of refractory gastro-esophageal reflux disease (GERD). The use of high resolution esophageal manometry (HRM) in preoperative evaluation is often applied to determine the degree of fundoplication to optimize reflux control while minimizing adverse sequela of postoperative dysphagia. OBJECTIVE Assess the role of preoperative HRM in predicting surgical outcomes, specifically risk assessment of postoperative dysphagia and quality of life, among patients receiving laparoscopic Nissen fundoplication for GERD with immediate postoperative (< 4 weeks clinic), short-term (3-month clinic), and long-term (34 ± 10.4 months of telephone) follow-up. METHODS Retrospective analysis of 146 patients over the age of 18 who received laparoscopic Nissen fundoplication at University of Vermont Medical Center from July 1, 2011 through December 31, 2014 was completed, of which 52 patients with preoperative HRM met inclusion criteria. Exclusion criteria included history of: (a) named esophageal motility disorder or aperistalsis; (b) esophageal cancer; (c) paraesophageal hernia noted intraoperatively. RESULTS Elevated basal integrated relaxation pressure (IRP), which is the mean of 4 s of maximal lower esophageal sphincter (LES) relaxation within 10 s of swallowing, was significantly correlated with worsened severity of post-fundoplication dysphagia (r = 0.572, p < 0.0001 with sensitivity and NPV of 100%) and poorer quality of life (r = 0.348, p = 0.018) at up to 3-years follow-up. The presence of preoperative dysphagia was independently related to post-fundoplication dysphagia at short-term (r = 0.403, p = 0.018) and long-term follow-up (r = 0.415, p = 0.005). Also, both elevated mean wave amplitude (r=-0.397, p = 0.006) and distal contractile integral (DCI) (r = - 0.294, p = 0.047) were significantly, inversely correlated to post-Nissen dysphagia. No significant association was demonstrated between other preoperative HRM parameters and surgical outcomes. CONCLUSIONS Inadequacy of lower esophageal sphincter (LES) relaxation with swallowing as delineated by elevated IRP is significantly predictive of worse long-term postoperative outcomes including dysphagia and quality of life scores. Further assessment of tailoring anti-reflux surgical approach with partial vs. total fundoplication to functionally resistant LES is required.
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Affiliation(s)
- Sonam Kapadia
- Dept of General Surgery, Harbor UCLA Medical Center, Los Angeles, CA, USA.
| | - Turner Osler
- Dept of General Surgery, University of Vermont Medical Center, Burlington, VT, USA
| | - Allen Lee
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Edward Borrazzo
- Dept of General Surgery, University of Vermont Medical Center, Burlington, VT, USA
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Abstract
Gastroesophageal reflux disease (GERD) is a common condition in infants. Symptoms from pathologic GERD include regurgitation, irritability when feeding, failure to thrive, and respiratory problems. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in neonates and infants include poor weight gain, failure to thrive, acute life-threatening events, and continued respiratory symptoms. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. In this procedure, the fundus of the stomach is wrapped 360° posteriorly around the lower esophagus.
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Affiliation(s)
- Bethany J Slater
- Pediatric Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 370, Denver, CO 80205, USA.
| | - Steven S Rothenberg
- Pediatric Surgery, Rocky Mountain Hospital for Children, 2055 High Street, Suite 370, Denver, CO 80205, USA
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Robertson JO, Jarboe MD. Long-Term Outcomes of Transoral Incisionless Fundoplication in a High-Risk Pediatric Population. J Laparoendosc Adv Surg Tech A 2017; 28:95-100. [PMID: 29049004 DOI: 10.1089/lap.2017.0257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Laparoscopic Nissen fundoplication (LNF) is the standard for surgical treatment of gastroesophageal reflux disease (GERD), but postoperative complications and pain are common in patients with severe neurological impairment (NI) and those undergoing reoperative procedures. Transoral incisionless fundoplication (TIF) is an endoscopic alternative to treat GERD. Long-term results in pediatric populations are unknown. METHODS Eleven patients who underwent TIF between January 2008 and September 2010 were included. A retrospective chart review was performed to evaluate long-term patient outcomes. Median follow-up was 5.6 years (range = 0.42-8.76 years). RESULTS Average patient age was 16.5 ± 5.1 years. Severe NI was present in 81.8% (9/11) of patients, and 63.6% (7/11) had undergone one or more prior fundoplication attempts. Overall, symptomatic reflux recurred or persisted in 54.5% (6/11) of patients. Recurrent symptoms were more common among those who had previous fundoplications than those who did not (71.4% [5/7] vs. 25% [1/4]). Four patients went on to require reoperation, including one laparoscopic Nissen and three disconnects. At last follow-up, 81.8% (9/11) of patients were still on antireflux medications. CONCLUSIONS This is the first report of long-term outcomes for treatment of GERD using TIF in a pediatric population. The recurrence rate was high, likely related to the fact that the population treated was extremely high risk. Recurrence was higher in patients with a prior fundoplication, perhaps identifying prior antireflux operations as a relative contraindication to TIF. Nevertheless, complications were low, and a subset of patients did receive a durable benefit from the procedure.
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Affiliation(s)
- Jason O Robertson
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan , Ann Arbor, Michigan
| | - Marcus D Jarboe
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan , Ann Arbor, Michigan
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Abstract
Gastroesophageal reflux disease (GERD) is a very common condition and affects approximately 7-20% of the pediatric population. Symptoms from pathological GERD include regurgitation, irritability when feeding, respiratory problems, and substernal pain. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in the pediatric population include failure of medical therapy with poor weight gain or failure to thrive, continued respiratory symptoms, and complications such as esophagitis. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. The key technical aspects of laparoscopic Nissen fundoplication include creation of an adequate intra-abdominal esophagus, minimal dissection of the hiatus with exposure of the right crus to identify the gastroesophageal junction, crural repair, and creation of floppy, 360° wrap that is oriented at the 11 o׳clock position.
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Affiliation(s)
- Bethany J Slater
- Pediatric Surgery, Rocky Mountain Hospital for Children, Denver, Colorado.
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Schwameis K, Zehetner J, Rona K, Crookes P, Bildzukewicz N, Oh DS, Ro G, Ross K, Sandhu K, Katkhouda N, Hagen JA, Lipham JC. Post- Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication. J Gastrointest Surg 2017; 21:441-445. [PMID: 27834011 DOI: 10.1007/s11605-016-3320-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Protracted dysphagia and bloating are potential troublesome side effects following Nissen fundoplication. The aim of this study was to evaluate the effects of conversion from Nissen to Toupet on dysphagia and bloating. METHODS The study used a retrospective chart review of all patients who had undergone conversion from Nissen to Toupet between 2001 and 2014. Endpoints were to determine the effect of conversion on dysphagia, bloating, and reflux control. RESULTS Twenty-five patients underwent conversion at a median of 3.7 years (1.4-10.5) after initial fundoplication. Indications were dysphagia in 19 (76%) and bloating syndrome in 6 (24%) patients. The median operative time was 104 min (86-146). There were no serious complications or mortality. Median follow-up was 27 months (0.8-130). Dysphagia was relieved in 16 (84%) and bloating in all 6 patients. Two patients developed reflux requiring a redo-Nissen. Two patients had persistent dysphagia and required endoscopic dilation. The GERD-HRQL post-conversion showed a median score of 5 (3-13). CONCLUSIONS Conversion relieved dysphagia in 84% and bloating in 100%. Significant recurrence of GERD was rare. Given the absence of serious complications, conversion should be considered in patients with severe bloating or dysphagia.
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Affiliation(s)
- Katrin Schwameis
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Jörg Zehetner
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Kais Rona
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Peter Crookes
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Nikolai Bildzukewicz
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Daniel S Oh
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Geoffrey Ro
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Katherine Ross
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Kulmeet Sandhu
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Namir Katkhouda
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Jeffrey A Hagen
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - John C Lipham
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
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Luo RB, Liu S, DeLong JC, Jacobsen GR, Sandler BJ, Horgan S. Laparoscopic Gastropleural Fistula Repair: A Minimally Invasive Solution for a Complex Problem. J Laparoendosc Adv Surg Tech A 2017; 27:416-419. [PMID: 28080207 DOI: 10.1089/lap.2016.0569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Gastropleural fistula (GPF) is a complex pathology that can present as a result of surgery, trauma, peptic ulcer disease, malignancies, radiation, or chemotherapy. Management typically includes endoscopic or surgical intervention along with intraabdominal or intrathoracic drainage of pre-existing infection. Traditionally, surgical approaches have been through exploratory laparotomy or thoracotomy, subjecting already ill patients to additional morbidity. CASE REPORT We describe and demonstrate a laparoscopic minimally invasive approach to the management of a GPF with a wedge resection of the stomach, along with a review of the current literature regarding GPF treatment. CONCLUSION GPF repair can be performed through laparoscopy and may lead to improved patient outcomes and faster recovery.
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Affiliation(s)
- Ran B Luo
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Shanglei Liu
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Jonathan C DeLong
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California San Diego , San Diego, California
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Rosemurgy AS, Downs D, Swaid F, Ross SB. Laparoendoscopic Single-Site (LESS) Nissen Fundoplication: How We Do It. J Gastrointest Surg 2016; 20:2093-9. [PMID: 27730403 DOI: 10.1007/s11605-016-3290-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/27/2016] [Indexed: 01/31/2023]
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Tolone S, Gualtieri G, Savarino E, Frazzoni M, de Bortoli N, Furnari M, Casalino G, Parisi S, Savarino V, Docimo L. Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors. World J Gastrointest Surg 2016; 8:719-728. [PMID: 27933133 PMCID: PMC5124700 DOI: 10.4240/wjgs.v8.i11.719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/17/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.
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Castelijns PSS, Ponten JEH, Van de Poll MCG, Nienhuijs SW, Smulders JF. Subjective outcome after laparoscopic hiatal hernia repair for intrathoracic stomach. Langenbecks Arch Surg 2016; 402:521-530. [PMID: 27830367 PMCID: PMC5410206 DOI: 10.1007/s00423-016-1504-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/04/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE For decades, an intrathoracic stomach (ITS) has been a definite indication for surgery due to the perceived risk of an acute volvulus with perforation, gangrene, or hemorrhage. At the present time, elective laparoscopic repair is the first choice for treatment of ITS. There is a lack of evidence in the long-term quality of life after a hiatal hernia repair for an intrathoracic stomach. METHODS A retrospective analysis was performed on all patients undergoing a hiatal hernia repair for an intrathoracic stomach between January 2004 and January 2015. Additionally, to a hiatal closure, the patients received an antireflux procedure. Outcome measures included patient characteristics, operative details, complications, and postoperative morbidity and mortality. All patients were sent a quality of life questionnaire to assess long-term quality of life and patient satisfaction. A higher quality of life score represents a better quality of life. RESULTS Eighty-six patients underwent laparoscopic repair for ITS, from which, one patient died during surgery. Eighty-five patients were contacted and 81 completed the questionnaire, resulting in a response rate of 95.3 %. At a median follow-up of 2.7 years (range 0.1-9.6), the mean quality of life score was 13.5 (standard deviation 2.8). The mean overall satisfaction was 8.4. There were four recurrences: three in the first 12 days after surgery and one in 2.4 years. CONCLUSIONS Very good results in patient satisfaction and symptom reduction were achieved after a median follow-up of 2.7 years in this laparoscopic repair of the intrathoracic stomach single center experience study. The symptomatic recurrence rate was very low.
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Affiliation(s)
- P S S Castelijns
- Departement of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - J E H Ponten
- Departement of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - M C G Van de Poll
- Departement of Surgery, MUMC+, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. .,Department of Intensive Care Medicine, MUMC+, P. Debeyelaan 25, 6229 HX, Maastricht, The Netherlands. .,School of Nutrition and Translational Research in Medicine, Maastricht University, Maastricht, The Netherlands.
| | - S W Nienhuijs
- Departement of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - J F Smulders
- Departement of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Du X, Hu Z, Yan C, Zhang C, Wang Z, Wu J. A meta-analysis of long follow-up outcomes of laparoscopic Nissen (total) versus Toupet (270°) fundoplication for gastro-esophageal reflux disease based on randomized controlled trials in adults. BMC Gastroenterol 2016; 16:88. [PMID: 27484006 PMCID: PMC4969978 DOI: 10.1186/s12876-016-0502-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 07/26/2016] [Indexed: 01/10/2023] Open
Abstract
Background Laparoscopic Nissen fundoplication (LNF) is the most common surgical procedure for the surgical management of gastro-esophageal reflux disease (GERD). Laparoscopic Toupet fundoplication (LTF) has been reported to have a lower prevalence of postoperative complications yet still obtain a similar level of reflux control. We conducted a meta-analysis to confirm the value of LNF and LTF. Methods PubMed, Medline, Embase, Cochrane Library and Springerlink were searched for randomized controlled trials (RCTs) comparing LNF and LTF. Data regarding the benefits and adverse results of two techniques were extracted and compared using a meta-analysis. Results Eight eligible RCTs comparing LNF (n = 625) and LTF (n = 567) were identified. There were no significant differences between LNF and LTF with regard to hospitalization duration, perioperative complications, patient satisfaction, postoperative heartburn, regurgitation, postoperative DeMeester scores, or esophagites. A shorter operative time and higher postoperative lower esophageal sphincter pressure were associated with LNF. Prevalence of postoperative dysphagia, gas-bloating, inability to belch, dilatation for dysphagia and reoperation were higher after LNF, but subgroup analyses showed that differences with respect to dysphagia between LNF and LTF disappeared over time. Subgroup analyses did not support “tailored therapy” according to preoperative esophageal motility. Conclusions LNF and LTF have equivalently good control of GERD and result in a similar prevalence of patient satisfaction. Based on current evidence, it is not rational or advisable to abandon LNF when choosing a surgical procedure for GERD.
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Affiliation(s)
- Xing Du
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhiwei Hu
- Department of Gastroesophageal Reflux Disease, the General Hospital of the PLA Rocket Force, Beijing, 100088, China
| | - Chao Yan
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Chao Zhang
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhonggao Wang
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, Beijing, 100053, China. .,Department of Gastroesophageal Reflux Disease, the General Hospital of the PLA Rocket Force, Beijing, 100088, China.
| | - Jimin Wu
- Department of Gastroesophageal Reflux Disease, the General Hospital of the PLA Rocket Force, Beijing, 100088, China
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Wang B, Zhang W, Liu S, Du Z, Shan C, Qiu M. A Chinese randomized prospective trial of floppy Nissen and Toupet fundoplication for gastroesophageal disease. Int J Surg 2015; 23:35-40. [PMID: 26360740 DOI: 10.1016/j.ijsu.2015.08.074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/28/2015] [Accepted: 08/14/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To evaluate the clinical outcomes of laparoscopic floppy Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) for the treatment of gastroesophageal disease (GERD). METHODS A total of 84 patients with GERD were randomized to either LNF (n = 43) or LTF (n = 41) between January 2010 and January 2013. The primary endpoint measures were the DeMeester score, distal esophageal amplitude (DEA), peristaltic frequency, lower esophageal sphincter pressure (LESP), short-term and long-term postoperative dysphagia and recurrence rate. The secondary endpoints were improvements in symptom scores and quality of life (QoL), and perioperative complications. RESULTS LNF group had a lower DeMeester score and a higher LESP compared to LTF group after surgery (DeMeester score: P = 0.007; LESP: P = 0.027). The mean DEA and peristaltic frequency both improved significantly after surgery in 2 groups. There was no difference in the incidence of short-term adverse events (including dysphagia, heartburn, regurgitation et al.) between the two groups (P = 0.157). At the time of the latest follow-up, there was no difference in the incidence of symptomatic reflux symptom (heartburn and regurgitation) between the two groups (heartburn: P = 0.363; regurgitation: P = 1.000). A higher frequency of dysphagia was present in the LNF group compared with the LTF group (P = 0.023). DISCUSSION LNF is associated with an excessive elevation of LESP which may lead to further persistent dysphagia. Partial fundoplication may provide adequate reflux control, improve esophageal body motility and minimize complications associated with an 'over-tight' fundal wrap. CONCLUSION LTF seems to be as safe and effective on the long-term as LNF, but with a lower incidence of postoperative dysphagia (ChiCTR-TRC-13003945).
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Affiliation(s)
- Bin Wang
- Department of General Surgery, The Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, China
| | - Wei Zhang
- Department of General Surgery, The Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, China
| | - Sheng Liu
- Department of General Surgery, The Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, China
| | - Zhipeng Du
- Department of General Surgery, The Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, China
| | - Chengxiang Shan
- Department of General Surgery, The Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, China.
| | - Ming Qiu
- Department of General Surgery, The Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai 200003, China.
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Weijenborg PW, Savarino E, Kessing BF, Roman S, Costantini M, Oors JM, Smout AJPM, Bredenoord AJ. Normal values of esophageal motility after antireflux surgery; a study using high-resolution manometry. Neurogastroenterol Motil 2015; 27:929-35. [PMID: 26095116 DOI: 10.1111/nmo.12554] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 02/26/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fundoplication is an effective therapy for gastroesophageal reflux disease (GERD), but can be complicated by postoperative dysphagia. High-resolution manometry (HRM) can assess esophageal function, but normal values after fundoplication are lacking. Our aim was to obtain normal values for HRM after successful Toupet and Nissen fundoplication. METHODS Esophageal HRM was performed 3 months after Toupet or Nissen fundoplication in 40 GERD patients without postoperative dysphagia and with a normal barium esophagogram. Normal values for all measures of the Chicago classification were calculated as 5th and 95th percentile ranges. KEY RESULTS The normal values (5th-95th percentiles) for integrated relaxation pressure (IRP) were higher after Nissen (5.1-24.4 mmHg) than after Toupet fundoplication (3.1-15.0 mmHg), and upper limit of normal was significantly higher after Nissen fundoplication than observed in the asymptomatic subjects that were described in the Chicago Classification. Distal contractile integral was significantly higher after Nissen (357-4947 mmHg*s*cm) than after Toupet (68-2177 mmHg*s*cm), and transition zone length was significantly shorter after Nissen (0-4.8 cm) than after Toupet fundoplication (0-12.8 cm). CONCLUSIONS & INFERENCES HRM metrics for subjects after a Toupet fundoplication are similar to the normal values derived from healthy subjects used for the Chicago classification. However, after Nissen fundoplication a higher esophagogastric junction resting pressure and higher IRP are observed in asymptomatic subjects and this can be considered normal in the postoperative state. In addition, more vigorous contractions and less and smaller peristaltic breaks are normal after Nissen fundoplication.
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Affiliation(s)
- P W Weijenborg
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - E Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - B F Kessing
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Roman
- Department of Digestive Physiology, Hospices Civils de Lyon, Lyon University, Lyon, France
| | - M Costantini
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - J M Oors
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - A J P M Smout
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - A J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
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Sload RL, Brigger MT. Surgery for reflux induced airway disease: a systematic review. Int J Pediatr Otorhinolaryngol 2014; 78:1211-5. [PMID: 24865806 DOI: 10.1016/j.ijporl.2014.04.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES 1. Evaluate the current evidence regarding the efficacy and safety of anti-reflux surgery for the treatment of severe gastroesophageal reflux-related airway disease in children. 2. Provide evidence based recommendations regarding indications and outcomes of anti-reflux surgery for airway disease in children. METHODS An a priori protocol was defined to identify all articles addressing anti-reflux surgery for the treatment of reflux-related airway disease in children where details regarding the diagnosis, treatment, and outcomes were clearly presented. The search was inclusive of all references available through August 30, 2013 and included electronic databases to identify candidate articles as well as a comprehensive series of crosschecks. The two authors independently determined which references met inclusion criteria, extracted data, and assigned levels of evidence. Data were pooled using a random effects model due to significant study heterogeneity. RESULTS Fourteen articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I(2)=82.7%; p<0.001). However, each article uniformly presented cases suggesting that anti-reflux surgery is efficacious and safe in treating children with severe reflux-related respiratory disease. The pooled success rate for complete or partial resolution of symptoms after anti-reflux surgery was 0.91 (95% CI: 0.88, 0.94). The pooled success rate for complete symptom resolution after surgery was 0.72 (95% CI: 0.62, 0.83). CONCLUSION The current literature suggests that anti-reflux surgery is an effective and safe treatment for severe reflux-related airway disease. However, the level of evidence lacks strength and further investigation is warranted.
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Affiliation(s)
- Ryan L Sload
- Naval Medical Center San Diego, Department of Otolaryngology - Head and Neck Surgery, San Diego, CA, 92134, United States
| | - Matthew T Brigger
- Naval Medical Center San Diego, Department of Otolaryngology - Head and Neck Surgery, San Diego, CA, 92134, United States.
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Weber B, Portnoy JE, Castellanos A, Hawkshaw MJ, Lurie D, Katz PO, Sataloff RT. Efficacy of anti-reflux surgery on refractory laryngopharyngeal reflux disease in professional voice users: a pilot study. J Voice. 2014;28:492-500. [PMID: 24629640 DOI: 10.1016/j.jvoice.2013.12.009s0892-1997(13)00256-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Laryngopharyngeal reflux (LPR) is a pervasive disorder that may cause hoarseness, throat clearing, and other symptoms. These symptoms are particularly problematic in professional voice users. Proton pump inhibitors (PPIs) are the mainstay of current medical management for LPR but may be insufficient in managing some patients' symptoms. Laparoscopic Nissen fundoplication (LNF) is well established for treatment of gastroesophageal reflux disease with a high success rate, but its role in the treatment of LPR remains uncertain. This study was designed to investigate the effectiveness of anti-reflux surgery in managing disease refractory to medical reflux therapy (twice of more per day PPIs). STUDY DESIGN Retrospective medical record review. METHODS This study examined 25 professional voice users, age ranging from 14 to 75 years, diagnosed with refractory LPR treated twice daily or more with PPIs. Reflux finding scores (RFS) were graded by blinded raters and compared for initial, preoperative, postoperative, and final visits. Twenty-four-hour pH-impedance study scores were obtained pre- and postoperatively. RESULTS Sixty percent of patients were on no-reflux medications postoperatively and an additional 24% were on less medication. RFS was not significantly different between pre- and postoperative evaluations with good inter- and intrarater reliability; postoperative examinations occurred on less or no pharmaceutical reflux treatment. Twenty-four-hour pH-impedance testing revealed significant reductions in reflux and a nearly significant reduction in total acid. Ninety percent of positive symptom indices preoperatively were negative postoperatively. Seventy-six percent of patients on BID dosing of PPIs and 86% of those receiving super-high-dose PPI administration who underwent LNF were satisfied with the results for their LPR disease. CONCLUSION LNF should be considered as a treatment option for professional voice users with LPR with symptoms refractory to standard or super-high-dose medical management. LNF may decrease or eliminate the need for postoperative PPI usage. The RFS may not be sensitive enough to monitor changes in LPR severity. Patients, especially those on super-high-dose medication administration, are satisfied with the improvement in LPR symptoms after anti-reflux surgery.
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Schijven MP, Gisbertz SS, van Berge Henegouwen MI. Laparoscopic surgery for gastro-esophageal acid reflux disease. Best Pract Res Clin Gastroenterol 2014; 28:97-109. [PMID: 24485258 DOI: 10.1016/j.bpg.2013.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/20/2013] [Indexed: 01/31/2023]
Abstract
Gastro-esophageal reflux disease is a troublesome disease for many patients, severely affecting their quality of life. Choice of treatment depends on a combination of patient characteristics and preferences, esophageal motility and damage of reflux, symptom severity and symptom correlation to acid reflux and physician preferences. Success of treatment depends on tailoring treatment modalities to the individual patient and adequate selection of treatment choice. PubMed, Embase, The Cochrane Database of Systematic Reviews, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for systematic reviews with an abstract, publication date within the last five years, in humans only, on key terms (laparosc* OR laparoscopy*) AND (fundoplication OR reflux* OR GORD OR GERD OR nissen OR toupet) NOT (achal* OR pediat*). Last search was performed on July 23nd and in total 54 articles were evaluated as relevant from this search. The laparoscopic Toupet fundoplication is the therapy of choice for normal-weight GERD patients qualifying for laparoscopic surgery. No better pharmaceutical, endoluminal or surgical alternatives are present to date. No firm conclusion can be stated on its cost-effectiveness. Results have to be awaited comparing the laparoscopic 180-degree anterior fundoplication with the Toupet fundoplication to be a possible better surgical alternative. Division of the short gastric vessels is not to be recommended, nor is the use of a bougie or a mesh in the vast majority of GERD patients undergoing surgery. The use of a robot is not recommended. Anti-reflux surgery is to be considered expert surgery, but there is no clear consensus what is to be called an 'expert surgeon'. As for setting, ambulatory settings seem promising although high-level evidence is lacking.
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Bonavina L, Saino G, Lipham JC, Demeester TR. LINX(®) Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux. Therap Adv Gastroenterol 2013; 6:261-8. [PMID: 23814607 PMCID: PMC3667475 DOI: 10.1177/1756283x13486311] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) results from incompetency of the lower esophageal sphincter that allows the contents of the stomach to reflux into the esophagus, the airways, and the mouth. The disease affects about 10% of the western population and has a profound negative impact on quality of life. The majority of patients are successfully treated with proton-pump inhibitors, but up to 40% have incomplete relief of symptoms even after dose adjustment. The laparoscopic Nissen fundoplication represents the surgical gold standard, but is largely underused because of the level of technical difficulty and the prevalence of side effects. These factors have contributed to the propensity of patients to continue with medical therapy despite inadequate symptom control and complications of the disease. As a consequence, a significant 'therapy gap' in the treatment of GERD remains evident in current clinical practice. The LINX(®) Reflux Management System (Torax Medical, St. Paul, MN, USA) is designed to provide a permanent solution to GERD by augmenting the sphincter barrier with a standardized, reproducible laparoscopic procedure that does not alter gastric anatomy and is easily reversible. Two single-group trials confirmed that a magnetic device designed to augment the lower esophageal sphincter can be safely and effectively implanted using a standard laparoscopic approach. The device decreased esophageal acid exposure, improved reflux symptoms and quality of life, and allowed cessation of proton-pump inhibitors in the majority of patients.
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Affiliation(s)
- Luigi Bonavina
- Division of General Surgery, Department of Biomedical Sciences for Health, University of Milano School of Medicine, via Morandi 30, 20097 San Donato Milanese, Milan, Italy
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Abstract
The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease (GERD) and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay, faster convalescence, and less postoperative pain. One controversy in the treatment of GERD evolves around laparoscopic antireflux surgery (LARS) as the preferred treatment for Barrett’s esophagus and the procedure’s potential to reduce the risk of adenocarcinoma of the esophagus. GERD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GERD. A new and promising alternative in the treatment of GERD is endoluminal therapy. Three types of this new treatment option will be discussed: radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter.
Laparoscopic surgery is discussed not only as a very effective treatment for GERD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia: medications, pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LARS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option, pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective non-surgical treatment for achalasia. Finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second concerns the necessity and type of antireflux procedure to prevent GERD after myotomy.
LARS and laparoscopic Heller myotomy are the agreed upon as the gold standards for surgical treatment of GERD and achalasia, respectively. In the hands of an experienced laparoscopic surgeon both are safe and effective treatments for patients with excellent subjective and objective long-term results with at least 90% patient satisfaction.
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Affiliation(s)
- Kurt-E Roberts
- Department of Surgery, Yale University School of Medicine, 40 Temple St. Suite 3A, New Haven, CT 06510, USA
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