1
|
Ibach MJ, Dahlke PM, Wiegrebe S, Hentschel F, Siemssen B. Medium-term outcomes after magnetic sphincter augmentation vs. fundoplication for reflux disease due to hiatal hernia: a propensity-score matched comparison in 282 patients. Surg Endosc 2024; 38:5068-5075. [PMID: 39014181 DOI: 10.1007/s00464-024-11011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND An increasing number of reflux patients opt for magnetic sphincter augmentation (MSA) instead of fundoplication. However, few studies compare the medium-term efficacy and safety of the procedures. METHODS We conducted a retrospective single-center analysis of consecutive MSA and Nissen fundoplication cases between 01/2015 and 06/2020. Patients underwent surgery, including hiatoplasty, for medical treatment-resistant reflux due to hiatal hernia. Surgical revision and proton pump inhibitor (PPI) reuptake rates were the primary outcomes. We also compared adverse event rates. Patients with severe preoperative dysphagia/motility disorders were assigned different treatment pathways and excluded from the analysis. We used propensity-score matching to reduce confounding between treatments. RESULTS Out of 411 eligible patients, 141 patients who underwent MSA and 141 with fundoplication had similar propensity scores and were analyzed. On average, patients were 55 ± 12 years old and overweight (BMI: 28 ± 5). At 3.9 years of mean follow-up, MSA was associated with lower surgical revision risk as compared to fundoplication (1.2% vs 3.0% per year, respectively; HR: 0.38; 95% CI 0.15-0.96; p = 0.04), and similar PPI-reuptake risk (2.6% vs 4.2% per year; HR: 0.59; 95% CI 0.30-1.16; p = 0.12). Adverse event rates during primary stay were similar (MSA vs. fundoplication: 1% vs. 3%, p = 0.68). Fewer patients experienced adverse events in the MSA group after discharge (24% vs. 33%, p = 0.11), driven by higher rates of self-limiting dysphagia (1% vs. 9%, p < 0.01) and gas/bloating (10% vs. 18%, p = 0.06) after fundoplication. Differences between MSA and fundoplication in dysphagia requiring diagnostic endoscopy (11% vs. 8%, p = 0.54) or surgical revision (2% vs. 1%, p = 1.0) were non-significant. The device explantation rate was 4% (5/141). CONCLUSION MSA reduces the re-operation risk compared to fundoplication and may decrease adverse event rates after discharge. Randomized head-to-head studies between available surgical options are needed.
Collapse
Affiliation(s)
| | - Paul Martin Dahlke
- Department of Surgery, Klinik Für MIC, Kurstr. 11, 14129, Berlin, Germany
| | - Simon Wiegrebe
- Statistical Consulting Unit StaBLab, Department of Statistics, LMU Munich, Munich, Germany
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Florian Hentschel
- Medizinische Hochschule Brandenburg, Universitätsklinikum Brandenburg an der Havel, Brandenburg, Germany
| | - Björn Siemssen
- Department of Surgery, Klinik Für MIC, Kurstr. 11, 14129, Berlin, Germany.
| |
Collapse
|
2
|
Frankel A, Thomson I, Shah A, Chen C, Zahir SF, Barbour A, Holtmann G, Mark Smithers B. Laparoscopic fundoplication versus laparoscopic Roux-en-Y gastric bypass for gastro-oesophageal reflux disease in obese patients: protocol for a randomized clinical trial. BJS Open 2022; 6:6849402. [PMID: 36440813 PMCID: PMC9703586 DOI: 10.1093/bjsopen/zrac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Laparoscopic fundoplication (LF) is the standard surgical procedure for the treatment of gastro-oesophageal reflux disease (GORD). Laparoscopic Roux-en-Y gastric bypass (LRYGB) is commonly performed to achieve weight loss in obese patients, but it also has anti-reflux properties. Hence, in the obese population suffering from GORD, LRYGB could be an alternative to LF. The aim of this trial will be to compare LF and LRYGB in an obese population presenting with GORD and being considered for surgery. METHODS This will be an investigator-initiated randomized clinical trial. The research population will be obese patients (BMI 30-34.9 with waist circumference more than 88 cm (women) or more than 102 cm (men), or BMI 35-40 with any waist circumference) referred to a public hospital for consideration of anti-reflux surgery. The primary aim of the study will be to determine the efficacy of LF compared with LRYGB on subjective and objective control of GORD. Secondary aims include determining early and late surgical morbidity and the side-effect profile of LF compared with LRYGB and to quantify any non-reflux benefits of LRYGB (including overall quality of life) compared with LF. CONCLUSION This trial will determine whether LRYGB is effective and acceptable as an alternative to LF for the surgical treatment of GORD in obese patients Registration number: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000636752p (https://www.anzctr.org.au/).
Collapse
Affiliation(s)
- Adam Frankel
- Correspondence to: Adam Frankel, Princess Alexandra Hospital, Upper GI Surgery, Ward 4D, 199 Ipswich Rd, Woolloongabba, Brisbane, Queensland, Australia 4102 (e-mail: )
| | - Iain Thomson
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Ayesha Shah
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Syeda Farah Zahir
- Queensland Facility for Advanced Bioinformatics, Queensland Cyber Infrastructure Foundation, Queensland, Australia
| | - Andrew Barbour
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerald Holtmann
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - B Mark Smithers
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| |
Collapse
|
3
|
How to choose among fundoplication, magnetic sphincter augmentation or transoral incisionless fundoplication. Curr Opin Gastroenterol 2019; 35:371-378. [PMID: 31033771 DOI: 10.1097/mog.0000000000000550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To examine current trends and research in nonmedical approaches to the treatment of gastroesophageal reflux disease (GERD). RECENT FINDINGS Long-term studies of GERD patients treated with transoral incisionless fundoplication (TIF) have found that a large portion of patients resume proton pump inhibitor therapy. In patients with uncomplicated GERD, magnetic sphincter augmentation (MSA) shows excellent short-term results in both patient satisfaction and physiologic measures of GERD, with fewer postoperative side-effects than fundoplication, although dysphagia can be problematic. SUMMARY Fundoplication remains the standard of care for patients with GERD complicated by hiatal hernias more than 2 cm, Barrett's esophagus and/or grade C and D erosive esophagitis. For the patient with uncomplicated GERD, MSA appears to be a viable alternative that has greater technical standardization and fewer postoperative side-effects than fundoplication. TIF remains an option for patients with refractory GERD who refuse surgical intervention.
Collapse
|
4
|
Kim JH, Kim BJ, Kim SW, Kim SE, Kim YS, Sung HY, Oh TH, Jeong ID, Park MI. [Current issues on gastroesophageal reflux disease]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 64:127-32. [PMID: 25252860 DOI: 10.4166/kjg.2014.64.3.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastroesophageal reflux disease (GERD) is one of the most common problems in gastrointestinal disorders. With the increase in our understanding on the pathophysiology of GERD along with the development of proton pump inhibitors, the diagnostic and therapeutic approaches to GERD have changed dramatically over the past decade. However, GERD still poses a problem to many clinicians since the spectrum of the disease has evolved to encompass more challenging presentations such as refractory GERD and extraesophageal manifestations. This has led to significant confusion regarding the optimal approach to these patients. This article aims to discuss current issues on GERD.
Collapse
Affiliation(s)
- Jie-Hyun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Seoul, Korea
| | - Beom Jin Kim
- Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang Wook Kim
- Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Eun Kim
- Kosin University College of Medicine, Busan, Korea
| | - Yeon Soo Kim
- Hallym University College of Medicine, Chuncheon, Korea
| | | | - Tae-Hoon Oh
- Inje University College of Medicine, Seoul, Korea
| | - In Du Jeong
- University of Ulsan College of Medicine, Ulsan, Korea
| | - Moo In Park
- Kosin University College of Medicine, Busan, Korea
| | | | | |
Collapse
|
5
|
Abstract
If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4-8 weeks. This should be taken 30-60 minutes before food for optimal effect. Once symptoms are controlled, attempt to withdraw acid suppression therapy. If symptoms recur, use the minimum dose that controls symptoms. Patients who have severe erosive oesophagitis, scleroderma oesophagus or Barrett's oesophagus require long-term treatment with a proton pump inhibitor. Lifestyle modification strategies can help gastro-oesophageal reflux disease. Weight loss has the strongest evidence for efficacy. Further investigation and a specialist referral are required if there is no response to proton pump inhibitor therapy. Atypical symptoms or signs of serious disease also need investigation.
Collapse
|
6
|
Glenn JA, Turaga KK, Gamblin TC, Hohmann SF, Johnston FM. Minimally invasive gastrectomy for cancer: current utilization in US academic medical centers. Surg Endosc 2015; 29:3768-75. [PMID: 25791064 DOI: 10.1007/s00464-015-4152-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internationally, the utilization of minimally invasive techniques for gastric cancer resection has been increasing since first introduced in 1994. In the USA, the feasibility and safety of these techniques for cancer have not yet been demonstrated. METHODS The University HealthSystem Consortium database was queried for gastrectomies performed between 2008 and 2013. Any adult patient with an abdominal visceral malignancy that necessitated gastric resection was included in the cohort. Clinicopathological and in-hospital outcome metrics were collected for open, laparoscopic, and robotic procedures. RESULTS Open gastrectomies comprised 89.5% of the total study group, while 8.2% of procedures were performed laparoscopically, and 2.3% were performed with robotic assistance. When accounting for disparities in patient severity of illness and risk of mortality subclass designations, there were no significant differences in mean length of stay, 30-day readmission, and in-hospital mortality between the three groups; however, mean total cost was highest in the robotic-assisted group (P = 0.017). Overall, complication rates were also similar; however, there was a higher incidence of superficial infection in the laparoscopic group (P = 0.013) and a higher incidence of venous thromboembolism in the robotic group (P = 0.038). CONCLUSION Despite widespread adoption for benign indications, minimally invasive gastrectomy for cancer remains underutilized in the USA. In these patients, laparoscopic and robot-assisted gastrectomies appear to be comparable to open resection with respect to overall complications, length of stay, 30-day readmission, and in-hospital mortality. However, when employing minimally invasive techniques, infection and thromboembolism risk reduction strategies should be emphasized in the operative and postoperative periods.
Collapse
Affiliation(s)
- Jason A Glenn
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Samuel F Hohmann
- University HealthSystem Consortium, 155 N Upper Wacker Dr, Chicago, IL, 60606, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| |
Collapse
|