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Gehwolf P, Agerer T, Stacul N, Kienzl-Wagner K, Schäfer A, Berchtold V, Cakar-Beck F, Elisabeth G, Wykypiel H. Lap. Nissen fundoplication leads to better respiratory symptom control than Toupet in the long term of 20 years. Langenbecks Arch Surg 2023; 408:372. [PMID: 37737866 PMCID: PMC10517034 DOI: 10.1007/s00423-023-03108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Having performed anti-reflux surgery for thirty years, it was important to reexamine our patients in the long term to enlarge the body of evidence concerning classical and extraesophageal symptoms that are differently controlled by Nissen or Toupet fundoplication. OBJECTIVES We report a cohort of 155 GERD patients who underwent fundoplication within a tailored approach between 1994 and 2000. Changes in the perioperative functional outcome, GERD symptoms, and quality of life are being analyzed 10 and 20 years after the operation. RESULTS The operation resulted in a superior quality of life compared to a patient cohort treated with PPI therapy. We found that both surgical methods (laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication) cure classical symptoms equally (heartburn, regurgitation, and dysphagia). GERD patients receiving a Toupet fundoplication seem more likely to suffer from extraesophageal GERD symptoms 10 and 20 years after surgery than patients with a Nissen fundoplication. On the other hand, some patients with Nissen fundoplication report dysphagia even 10 and 20 years after surgery. CONCLUSION Both the laparoscopic Nissen and Toupet fundoplications provide excellent symptom control in the long term. Moreover, the Nissen fundoplication seems to be superior in controlling extraesophageal reflux symptoms, but at the expense of dysphagia. In summary, tailoring the operation based on symptoms seems advantageous.
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Affiliation(s)
- Philipp Gehwolf
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria.
| | - Teresa Agerer
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Nadine Stacul
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Katrin Kienzl-Wagner
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Aline Schäfer
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Valeria Berchtold
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Fergül Cakar-Beck
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Gasser Elisabeth
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
| | - Heinz Wykypiel
- Department of Visceral, Transplant, and Thoracic Surgery (VTT), Center of Operative Medicine, Medical University of Innsbruck (MUI), 6020, Innsbruck, Austria
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Salman MA, Salman A, Shaaban HED, Alasmar M, Tourky M, Elhaj MGF, Khalid S, Gebril M, Alrahawy M, Elsherbiney M, Assal MM, Osman MHA, Mohammed AA, Elewa A. Nissen Versus Toupet Fundoplication For Gastro-oesophageal Reflux Disease, Short And Long-term Outcomes. A Systematic Review And Meta-analysis. Surg Laparosc Endosc Percutan Tech 2023; 33:171-183. [PMID: 36971517 DOI: 10.1097/sle.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/22/2022] [Indexed: 03/29/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) remains one of the most commonly encountered gastrointestinal disorders. Proton pump inhibitors still show an inadequate effect on about 10% to 40% of the patients. Laparoscopic antireflux surgery is the surgical alternative for managing GERD in patients who are not responding to proton pump inhibitors. AIM OF THE STUDY This study objected at comparing laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication (LTF) concerning the short-term and long-term outcomes. PATIENTS AND METHODS This is a systematic review and meta-analysis that evaluated the studies comparing between Nissen fundoplication and LTF for the treatment of GERD. Studies were obtained by searching on the EMBASE, the Cochrane Central Register of Controlled Trials, and PubMed central database. RESULTS The LTF group showed significantly longer operation time, less postoperative dysphagia and gas bloating, less pressure on the lower esophageal sphincter, and higher Demeester scores. No statistically significant differences were found between the 2 groups in the perioperative complications, the recurrence of GERD, the reoperation rate, the quality of life, or the reoperation rate. CONCLUSION LTF is favored for the surgical treatment of GERD being of lower postoperative dysphagia and gas bloating rates. These benefits were not at the expense of significantly additional perioperative complications or surgery failure.
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Affiliation(s)
| | - Ahmed Salman
- Internal Medicine, Kasralainy School of Medicine, Cairo University, Giza
| | - Hossam El-Din Shaaban
- National Hepatology and Tropical Medicine Research Institute, Gastroenterology and Hepatology, Cairo, Egypt
| | - Mohamed Alasmar
- General/OesophagoGastric Surgery, Salford Royal Hospital, Manchester
- Division of Cancer Sciences, University of Manchester
| | | | | | | | | | | | | | | | | | | | - Ahmed Elewa
- Laparoscopic and HBP Surgery at National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
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Tailoring Endoscopic and Surgical Treatments for Gastroesophageal Reflux Disease. Gastroenterol Clin North Am 2020; 49:467-480. [PMID: 32718565 DOI: 10.1016/j.gtc.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of gastroesophageal reflux disease (GERD) remains on the rise. Pathophysiology of GERD is multifactorial, revolving around an incompetent esophagogastric junction as an antireflux barrier, with other comorbid conditions contributing to the disease. Proton pump inhibitors remain the most common treatment of GERD. Endoscopic therapy has gained popularity as a less invasive option. The presence of esophageal dysmotility complicates the choice of surgical fundoplication. Most literature demonstrates that fundoplication is safe in the setting of ineffective or weak peristalsis and that postoperative dysphagia cannot be predicted by preoperative manometry parameters. More data are needed on the merits of endoluminal approaches to GERD.
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Gyawali CP, Roman S, Bredenoord AJ, Fox M, Keller J, Pandolfino JE, Sifrim D, Tatum R, Yadlapati R, Savarino E. Classification of esophageal motor findings in gastro-esophageal reflux disease: Conclusions from an international consensus group. Neurogastroenterol Motil 2017; 29. [PMID: 28544357 DOI: 10.1111/nmo.13104] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/10/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD. METHODS Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated. KEY RESULTS Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD. CONCLUSIONS & INFERENCES Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM.
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Affiliation(s)
- C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA
| | - S Roman
- Digestive Physiology, Hospices Civils de Lyon and Lyon I University and Inserm U1032, LabTAU, Lyon, France
| | - A J Bredenoord
- Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - M Fox
- Department of Gastroenterology, Abdominal Center, St. Claraspital, Basel, Switzerland
| | - J Keller
- Department of Internal Medicine, Israelitic Hospital, University of Hamburg, Hamburg, Germany
| | - J E Pandolfino
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - D Sifrim
- Center for Digestive Diseases, Bart's and the London School and Dentistry, London, UK
| | - R Tatum
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - R Yadlapati
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - E Savarino
- Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, Padua, Italy
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DeHaan RK, Davila D, Frelich MJ, Gould JC. Esophagogastric junction distensibility is greater following Toupet compared to Nissen fundoplication. Surg Endosc 2016; 31:193-198. [DOI: 10.1007/s00464-016-4956-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/18/2016] [Indexed: 01/16/2023]
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Tian ZC, Wang B, Shan CX, Zhang W, Jiang DZ, Qiu M. A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease. PLoS One 2015; 10:e0127627. [PMID: 26121646 PMCID: PMC4484805 DOI: 10.1371/journal.pone.0127627] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/17/2015] [Indexed: 01/28/2023] Open
Abstract
Aim In recent years, several studies with large sample sizes and recent follow-up data have been published comparing outcomes between laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication. It is now timely to be re-evaluated and synthesized long-term efficacy and adverse events of both total and partial posterior fundoplication. Materials and Methods Electronic searches for RCTs comparing the outcome after laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication were performed in the databases of MEDLINE, EMBASE, and the Cochrane Center Register of Controlled Trials. The data of evaluation in positive and adverse results of laparoscopic Nissen fundoplication and laparoscopic Nissen fundoplication were extracted and compared using meta-analysis. Results 13 RCTs were ultimately identified involving 814 (52.05%) and 750 (47.95%) patients who underwent laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication, respectively. The operative time, perioperative complications, postoperative satisfaction, recurrence, and the rates of medication adoption or re-operation due to recurrence were not significantly different between two groups. The two types of fundoplication both reinforced the anti-reflux barrier and elevated the lower esophageal sphincter pressure. However, rates of adverse results involving dysphasia, gas-bloat syndrome, inability to belch and re-operation due to severe dysphasia were significantly higher after LNF. In the subgroup analysis of wrap length≤2cm, laparoscopic Nissen fundoplication was associated with a significantly higher incidence of postoperative dysphagia. However, in the subgroup wrap length>2cm, the difference was not statistically significant. Conclusion Laparoscopic Toupet fundoplication might be the better surgery approach for gastroesophageal reflux disease with a lower rate of postoperative adverse results and equal effectiveness as Laparoscopic Nissen fundoplication.
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Affiliation(s)
- Zhi-chao Tian
- Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China
| | - Bin Wang
- Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China
| | - Cheng-xiang Shan
- Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China
| | - Wei Zhang
- Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China
| | - Dao-zhen Jiang
- Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China
| | - Ming Qiu
- Department of General Surgery of Changzheng Hospital affiliated to Second Military Medical University, No.415 Fengyang road, Shanghai, 200003 China
- * E-mail:
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Lin DC, Chun CL, Triadafilopoulos G. Evaluation and management of patients with symptoms after anti-reflux surgery. Dis Esophagus 2015; 28:1-10. [PMID: 23826861 DOI: 10.1111/dote.12103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the past two decades, there has been an increase in the number of anti-reflux operations being performed. This is mostly due to the use of laparoscopic techniques, the increasing prevalence of gastroesophageal reflux disease (GERD) in the population, and the increasing unwillingness of patients to take acid suppressive medications for life. Laparoscopic fundoplication is now widely available in both academic and community hospitals, has a limited length of stay and postoperative recovery time, and is associated with excellent outcomes in carefully selected patients. Although the operation has low mortality and postoperative morbidity, it is associated with late postoperative complications, such as gas bloat syndrome, dysphagia, diarrhea, and recurrent GERD symptoms. This review summarizes the diagnostic evaluation and appropriate management of such postoperative complications. If a reoperation is needed, it should be performed by experienced foregut surgeons.
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Affiliation(s)
- D C Lin
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Abstract
Globus is a topic of interest for many specialties including otorhinolaryngology, gastroenterology and psychiatry/psychosomatic medicine, but, although many hypotheses have been suggested, key questions about its aetiology remain. This Review provides an overview of the extensive literature concerning this topic and discusses the quality of the evidence to date. Globus has been associated with oropharyngeal structural lesions, upper oesophageal sphincter disorders, oesophageal disorders, GERD, psychosocial factors and psychiatric comorbidity. However, findings are often contradictory and the literature remains highly inconclusive. Indeed, with the exception of patients with structural-based globus, the Rome III criteria for functional globus only apply to a subgroup of patients with idiopathic globus. In clinical reality, there exists a group of patients who present with idiopathic (nonstructural) globus, but nevertheless have dysphagia, odynophagia or GERD-exclusion criteria for globus diagnosis according to Rome III. The symptomatology of patients with globus might be broader than previously thought. It is therefore crucial to approach globus not from one single perspective, but from a multifactorial point of view, with focus on the coexistence and/or interactions of different mechanisms in globus pathogenesis. This approach could be translated to clinical practice by adopting a multidisciplinary method to patients presenting with globus.
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Abstract
High-resolution manometry (HRM) allows nuanced evaluation of esophageal motor function, and more accurate evaluation of lower esophageal sphincter (LES) function, in comparison with conventional manometry. Pathophysiologic correlates of gastroesophageal reflux disease (GERD) and esophageal peristaltic performance are well addressed by this technique. HRM may alter the surgical decision by assessment of esophageal peristaltic function and exclusion of esophageal outflow obstruction before antireflux surgery. Provocative testing during HRM may assess esophageal smooth muscle peristaltic reserve and help predict the likelihood of transit symptoms following antireflux surgery. HRM represents a continuously evolving new technology that compliments the evaluation and management of GERD.
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Affiliation(s)
- Michael Mello
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, Campus Box 8124, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Mickevičius A, Endzinas Ž, Kiudelis M, Jonaitis L, Kupčinskas L, Pundzius J, Maleckas A. Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study. Surg Endosc 2012; 27:986-91. [PMID: 23052526 DOI: 10.1007/s00464-012-2550-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 08/21/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Long-term results in antireflux surgery may depend on fundoplication type and wrap length. We compared the outcome of two different wrap lengths among the patients undergoing partial or total fundoplications. This study is the next part of a prospective 5-year follow-up assessment. METHODS A total of 153 patients were randomized to Nissen or Toupet 1.5- or 3-cm wrap laparoscopic fundoplication. The primary endpoint--treatment failure rate was defined as a recurrent GERD or persistent dysphagia. Intensity of heartburn, dysphagia, gas-bloating, presence of esophagitis were assessed as a secondary outcome at 1-year and 5-year follow-up. RESULTS At 5-year follow-up, data were collected from 129 (85 %) patients. At 1-year follow-up, 17 (11 %) treatment failures were detected. At the end of the fifth year, the numbers reached 23 (15 %). The failures were more common in the 1.5-cm Toupet (25 %) and the 3-cm Nissen group (18.2 %). The significant difference in failure rates was found between 1.5-cm and 3-cm Toupet groups (P < 0.05). Dysphagia remained low during the follow-up in all of the groups. The prevalence of higher scores of heartburn after 5 years was detected in Nissen 1.5-cm group (20.8 %). The lowest scores were observed in Toupet 3-cm group. Bloating symptoms were more prevalent among Nissen and Toupet 3-cm group patients at 5-year follow-up. At the end of the fifth year, the prevalence of esophagitis was lower in Nissen 1.5-cm (19.3 %) and Toupet 3-cm (13.3 %) groups. The highest prevalence of esophagitis-32.4 %-was found in Toupet 1.5-cm group. CONCLUSIONS Nissen and Toupet fundoplication achieved sufficient control of reflux with success rate of 85 % at 5-year follow-up. There were no significant differences in the postoperative dysphagia, esophagitis, and bloating rates. However, the distribution of treatment failures leads us to conclude that 1.5-cm wrap length is insufficient in cases of posterior partial fundoplication.
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Affiliation(s)
- Antanas Mickevičius
- Surgery Department, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, Lithuania.
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Parise P, Rosati R, Savarino E, Locatelli A, Ceolin M, Dua KS, Tatum RP, Braghetto I, Gyawali CP, Hejazi RA, McCallum RW, Sarosiek I, Bonavina L, Wassenaar EB, Pellegrini CA, Jacobson BC, Canon CL, Badaloni A, del Genio G. Barrett's esophagus: surgical treatments. Ann N Y Acad Sci 2011; 1232:175-95. [PMID: 21950813 DOI: 10.1111/j.1749-6632.2011.06051.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The following on surgical treatments for Barrett's esophagus includes commentaries on the indications for antireflux surgery after medical treatment; the effects of the various procedures on the lower esophageal sphincter; the role of impaired esophageal motility and delayed gastric emptying in the choice of the surgical procedure; indications for associated highly selective vagotomy, duodenal switch, and gastric electrical stimulation; therapeutic strategies for detection and treatment of shortened esophagus; the role of antireflux surgery on the regression of metaplastic mucosa and the risk of malignant progression; the detection of asymptomatic reflux brfore bariatric surgery; the role of non-GERD symptoms on the results of surgery; and the indications of Collis gastroplasty and choice of the type of fundoplication.
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Affiliation(s)
- Paolo Parise
- Department of General Surgery IV, Regional Referal Center for Esophageal Pathology, Pisa, Italy
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Shan CX, Zhang W, Zheng XM, Jiang DZ, Liu S, Qiu M. Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease. World J Gastroenterol 2010; 16:3063-71. [PMID: 20572311 PMCID: PMC2890948 DOI: 10.3748/wjg.v16.i24.3063] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To demonstrate the optimal surgical procedure for gastroesophageal reflux disease.
METHODS: The electronic databases of Medline, Elsevier, Springerlink and Embase over the last 16 years were searched. All clinical trials involved in the outcomes of laparoscopic Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) were identified. The data of assessment in benefits and adverse results of LNF and LTF were extracted and compared using meta-analysis.
RESULTS: We ultimately identified a total of 32 references reporting nine randomized controlled trials, eight prospective cohort trials and 15 retrospective trials. These studies reported a total of 6236 patients, of whom 4252 (68.18%) underwent LNF and 1984 (31.82%) underwent LTF. There were no differences between LNF and LTF in patients’ satisfaction, perioperative complications, postoperative heartburn, reflux recurrence and re-operation. Both LNF and LTF enhanced the function of lower esophageal sphincter and improved esophagitis. The postoperative dysphagia, gas-bloating syndrome, inability to belch and the need for dilatation after LNF were more common than after LTF. Subgroup analyses showed that dysphagia after LNF and LTF was similar in patients with normal esophageal peristalsis (EP), but occurred more frequently in patients with weak EP after LNF than after LTF. Furthermore, patients with normal EP after LNF still had a higher risk of developing dysphagia than did patients with abnormal EP after LTF.
CONCLUSION: Compared with LNF, LTF offers equivalent symptom relief and reduces adverse results.
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Schuchert MJ, Pettiford BL, Abbas G, Oostdyk A, Landreneau JR, Kilic A, Landreneau JP, Luketich JD, Landreneau RJ. The use of esophageal transit and gastric emptying studies in the evaluation of patients undergoing laparoscopic fundoplication. Surg Endosc 2010; 24:3119-26. [PMID: 20490564 DOI: 10.1007/s00464-010-1099-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
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Tsimogiannis KE, Pappas-Gogos GK, Benetatos N, Tsironis D, Farantos C, Tsimoyiannis EC. Laparoscopic Nissen fundoplication combined with posterior gastropexy in surgical treatment of GERD. Surg Endosc 2009; 24:1303-9. [PMID: 19960205 DOI: 10.1007/s00464-009-0764-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 10/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscopic Nissen fundoplication (LNF) has become established as the procedure of choice in the surgical management of the majority of patients suffering from gastroesophageal reflux disease (GERD). Postoperative paraesophageal herniation has an incidence range up to 7% in the immediate postoperative period. AIM A prospective randomized trial was scheduled to study the role of posterior gastropexy, in combination with LNF, in prevention of paraesophageal herniation and improvement of postoperative results in surgical treatment of GERD. PATIENTS AND METHODS Eighty-two patients with GERD were randomized to LNF combined with (group A, n = 40) or without (group B, n = 42) posterior gastropexy. Subjective evaluation using disease-specific and generic questionnaires and structured interviews, and objective evaluation by endoscopy, esophageal manometry, and 24-h pH monitoring, were performed before operation, at 2 and 12 months after surgery, and then every year. Crura approximation was performed by stitches if the diameter was less than 6 cm, or with a patch to reinforce the conventional crural closure or by tension-free technique to close the hiatus. Posterior gastropexy (group A) was performed with one stitch between the posterior wall of the wrap and the crura near the arcuate ligament. RESULTS Sixteen patients of group A and 15 patients of group B with concomitant abdominal diseases had simultaneous procedures [cholecystectomy 25, vagotomy 2, ventral hernia repair 1, gastric polypectomy 1, gastric fundus diverticulectomy 1, gastrointestinal stromal tumor (GIST) wedge resection 1]. In mean follow-up of 48 +/- 26 months (range 7-94 months), one patient of group B presented with paraesophageal herniation in the first postoperative month (reoperation), while recurrent gastroesophageal reflux (Visick III or IV), successfully treated by medication, was noted in three patients of group B and in one patient of group A. Only mild dysphagia, during the first two postoperative months, was noted in nine patients of group A and eight patients of group B. Six patients of each group with Barrett's esophagus had endoscopic improvement after the second postoperative month. Visick score in groups A/B was I in 26/11 (P < 0.0001), II in 13/27 (P = 0.037), III in 1/2 (not significant, NS), and IV in 0/2. Generally, Visick score was I or II in 39/38 in groups A/B (97.5%/90.5%, NS) and III or IV in 1/4 (2.5%/9.5%, P < 0.0001). CONCLUSIONS LNF combined with posterior gastropexy may prevent postoperative paraesophageal or sliding herniation in surgical treatment of GERD, providing better early and long-term postoperative results. (Registered Clinical Trial number: NCT00872755. www.clinicaltrials.gov .).
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Asymptomatic free intraperitoneal gas with duodenal stenosis. Clin J Gastroenterol 2009; 2:338-342. [PMID: 26192609 DOI: 10.1007/s12328-009-0104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
Abstract
A 30-year-old man was referred to our hospital in October 2006 for asymptomatic free air in the peritoneal cavity found on a plain chest X-ray on a routine health examination. Esophagogastroduodenoscopy (EGD) revealed an ulcer scar and deformity of the duodenal bulb, a healing-phase ulcer in the anterior wall of the upper gastric corpus, grade B esophagitis (Los Angeles grading system), and a sliding hiatal hernia. A test for Helicobacter pylori was negative. Upon obtaining an informed consent (asymptomatic perforation), laparoscopic selective proximal vagotomy, Toupet fundoplication, and small skin incision Finney pyloroplasty were performed. Intraoperatively, extensive adhesions of the greater omentum to the duodenal bulb were found, which were suspected to engulf the cryptic perforation. The patient's postoperative course has been uneventful and, at present, recurrence of the ulcer has not been observed. The presented case is rare considering the absence of surgical history, lack of symptoms, and incidental finding of the intraperitoneal free air during a health examination.
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Oláh T. [Surgery of oesophagus]. Magy Seb 2009; 62:204-212. [PMID: 19679529 DOI: 10.1556/maseb.62.2009.4.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Tibor Oláh
- Kaposi Mór Oktató Kórház Altalános Sebészeti, Er- és Mellkassebészeti Osztály Siófok
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Tibbling L, Johansson M, Mjönes AB, Franzén T. Globus jugularis and dysphagia in patients with hiatus hernia. Eur Arch Otorhinolaryngol 2009; 267:251-4. [PMID: 19597835 DOI: 10.1007/s00405-009-1038-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 06/24/2009] [Indexed: 01/29/2023]
Abstract
The aim of the article was to study if there is any relationship between globus sensation in the jugular fossa (GJ), intermittent esophageal dysphagia (IED), and the presence of a hiatus hernia, and if GJ can be relieved after hiatus hernia repair. 167 patients with a hiatus hernia (Group A) and 61 other patients with hiatus hernia and gastroesophageal reflux disease who were surgically treated with Nissen fundoplication (Group B), filled in a symptom questionnaire on GJ and IED. GJ was found in 66% and IED in 68% of patients in group A. In group B, 49% had GJ and 64% IED before surgery. At surgical follow-up 16% (P < 0.005) and 43% (P < 0.05) had GJ and IED, respectively. The combination of GJ and IED was found in 28% of IED patients before operation and in 31% at surgical follow-up. The high frequency of GJ in patients with hiatus hernia and the significant relief of GJ after hiatus hernia repair imply that GJ most likely is a referred sensation from the esophagus. IED and GJ are two parallel phenomena in patients with hiatus hernia, but do not seem to have any causal relationship.
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Affiliation(s)
- L Tibbling
- Department of Surgery, Linköping University Hospital, 581 85 Linköping, Sweden
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Wykypiel H, Wetscher G. On: laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility [Surg Endosc 22(1):21-30]. Surg Endosc 2008; 22:2095-6. [PMID: 18553209 DOI: 10.1007/s00464-008-0002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/12/2008] [Indexed: 12/25/2022]
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