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Lata T, Trautman J, Townend P, Wilson RB. Current management of gastro-oesophageal reflux disease-treatment costs, safety profile, and effectiveness: a narrative review. Gastroenterol Rep (Oxf) 2023; 11:goad008. [PMID: 37082451 PMCID: PMC10112961 DOI: 10.1093/gastro/goad008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 12/09/2022] [Accepted: 02/01/2023] [Indexed: 04/22/2023] Open
Abstract
Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease (GORD), including treatment costs, safety profile and effectiveness. Methods A literature review was performed of randomized-controlled trials, systematic reviews, Cochrane reports and National/Societal guidelines of the medical, endoscopic and surgical management of GORD. Proton pump inhibitor (PPI) prescribing patterns and expenditure were reviewed in different countries, including Australia, Canada, New Zealand, UK and USA. Results Proton pump inhibitors (PPIs) are primarily indicated for control of GORD, Helicobacter pylori eradication (combined with antibiotics), preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer disease. There is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration, with substantial expense for national health providers. Despite a favourable short-term safety profile, there are observational associations of adverse effects with long-term PPIs. These include nutrient malabsorption, enteric infections and cardiovascular events. The prevalence of PPI use makes their long-term safety profile clinically relevant. Cost-benefit, symptom control and quality-of-life outcomes favour laparoscopic fundoplication rather than chronic PPI treatment. Laparoscopic fundoplication in long-term management of PPI-responsive GORD is supported by SAGES, NICE and ACG, and PPI-refractory GORD by AGA and SAGES guidelines. The importance of establishing a definitive diagnosis prior to invasive management is emphasized, especially in PPI-refractory heartburn. Conclusions We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health professionals. This narrative review presents the advantages and disadvantages of surgical, endoscopic and medical management of GORD, which may assist in shared decision making and treatment choice in individual patients.This paper was presented (GS020) at the 88th RACS Annual Scientific Conference, 6-10 May, 2019.
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Affiliation(s)
- Tahmina Lata
- Corresponding author. Faculty of Medicine and Health, University of Sydney, City Road, Camperdown, NSW 2006, Australia. Tel: +0061-2-93512222.
| | - Jodie Trautman
- General Surgery Department, Wollongong Hospital, Wollongong, NSW, Australia
| | - Philip Townend
- General Surgery Department, Gold Coast University Hospital, Southport, QLD, Australia
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O'Neill SM, Jalilvand AD, Colvin JS, Haisley KR, Perry KA. S148: Long-term patient-reported outcomes of laparoscopic magnetic sphincter augmentation versus Nissen fundoplication: a 5-year follow-up study. Surg Endosc 2022; 36:6851-6858. [PMID: 35041056 DOI: 10.1007/s00464-022-09015-1] [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: 09/02/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laparoscopic magnetic sphincter augmentation (MSA) has emerged as an alternative to laparoscopic Nissen fundoplication (LNF) for the management of symptomatic gastroesophageal reflux disease (GERD). While short-term outcomes of MSA compare favorably to those of LNF, direct comparisons of long-term outcomes are lacking. We hypothesized that the long-term patient-reported outcomes of MSA would be similar to those achieved with LNF. METHODS We tested this hypothesis in a retrospective cohort undergoing primary LNF or MSA between March 2013 and July 2015. The primary outcome was GERD-Health Related Quality of Life (GERD-HRQL) score at long-term follow-up relative to baseline. Secondary outcomes included dysphagia and bloating scores, proton-pump inhibitor (PPI) cessation, reoperations, and overall satisfaction with surgery. RESULTS 70 patients (25 MSA, 45 LNF) met criteria for study inclusion. MSA patients had lower baseline BMI (median: 27.1 [IQR: 22.7-29.9] versus 30.4 [26.4-32.8], p = 0.02), lower total GERD-HRQL (26 [19-32] versus 34 [25-40], p = 0.02), and dysphagia (2 [0-3] versus 3 [1-4], p = 0.02) scores. Median follow-up interval exceeded 5 years (MSA: 68 [65-74]; LNF: 65 months [62-69]). Total GERD-HRQL improved from 26 to 9 after MSA (p < 0.001) and from 34 to 7.5 after LNF (p < 0.01); these scores did not differ between groups (p = 0.68). Dysphagia (MSA: 1 [0-2]; LNF: 0 [0-2], p = 0.96) and bloating (MSA: 1.5 [0.5-3.0]; LNF: 3.0 [1.0-4.0], p = 0.08) scores did not show any statistically significant differences. Device removal was performed in 4 (16%) MSA patients and reoperation in 3 (7%) LNF patients. Eighty-nine percent of LNF patients reported satisfaction with the procedure, compared to 70% of MSA patients (p = 0.09). CONCLUSIONS MSA appears to offer similar long-term improvement in disease-specific quality of life as LNF. For MSA, there was a trend toward reduced long-term bloating compared to LNF, but need for reoperation and device removal may be associated with patient dissatisfaction.
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Affiliation(s)
- Sean M O'Neill
- Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Anahita D Jalilvand
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer S Colvin
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Kelly R Haisley
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W 10th Ave, Columbus, OH, USA
| | - Kyle A Perry
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W 10th Ave, Columbus, OH, USA.
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Maret-Ouda J, Yanes M, Konings P, Brusselaers N, Lagergren J. Mortality from laparoscopic antireflux surgery in a nationwide cohort of the working-age population. Br J Surg 2016; 103:863-70. [DOI: 10.1002/bjs.10141] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/18/2015] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
Abstract
Abstract
Background
Both medication and surgery are effective treatments for severe gastro-oesophageal reflux disease (GORD). Postoperative risks have contributed to decreased use of antireflux surgery. The aim of this study was to assess short-term mortality following primary laparoscopic fundoplication.
Methods
This was a population-based nationwide cohort study including all Swedish hospitals that performed laparoscopic fundoplication between 1997 and 2013. All patients aged 18–65 years with GORD who underwent primary laparoscopic fundoplication during the study interval were included. The primary outcome was absolute all-cause and surgery-related 90- and 30-day mortality. Secondary outcomes were reoperation and length of hospital stay. Logistic regression was used to calculate odds ratios with 95 per cent confidence intervals of reoperation within 90 days and prolonged hospital stay (4 days or more).
Results
Of 8947 included patients, 5306 (59·3 per cent) were men and 551 (6·2 per cent) had significant co-morbidity (Charlson score above 0). Median age at surgery was 48 years, and median hospital stay was 2 days. The annual rate of laparoscopic fundoplication decreased from 15·3 to 2·4 patients per 100 000 population during the study period, whereas the proportion of patients with co-morbidity increased more than twofold. All-cause 90- and 30-day mortality rates were 0·08 per cent (7 patients) and 0·03 per cent (3 patients) respectively. Only one death (0·01 per cent) was directly surgery-related. The 90-day reoperation rate was 0·4 per cent (39 patients). Co-morbidity and older age were associated with an increased risk of prolonged hospital stay, but not reoperation.
Conclusion
This population-based study revealed very low mortality and reoperation rates following primary laparoscopic fundoplication in the working-age population. The findings may influence clinical decision-making in the treatment of severe GORD.
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Affiliation(s)
- J Maret-Ouda
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - M Yanes
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - P Konings
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - N Brusselaers
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - J Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
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Hendy P. Transoral oesophagogastric fundoplication is effective in treating proton pump inhibitor-resistant regurgitation. Frontline Gastroenterol 2016; 7:2-3. [PMID: 28839828 PMCID: PMC5369517 DOI: 10.1136/flgastro-2015-100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Håkansson B, Montgomery M, Cadiere GB, Rajan A, Bruley des Varannes S, Lerhun M, Coron E, Tack J, Bischops R, Thorell A, Arnelo U, Lundell L. Randomised clinical trial: transoral incisionless fundoplication vs. sham intervention to control chronic GERD. Aliment Pharmacol Ther 2015; 42:1261-70. [PMID: 26463242 DOI: 10.1111/apt.13427] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/08/2015] [Accepted: 09/21/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Until recently only two therapeutic options have been available to control symptoms and the esophagitis in chronic gastro-oesophageal reflux disease (GERD), i.e. lifelong proton pump inhibitor (PPI) therapy or anti-reflux surgery. Lately, transoral incisionless fundoplication (TIF) has been developed and found to offer a therapeutic alternative for these patients. AIM To perform a double-blind sham-controlled study in GERD patients who were chronic PPI users. METHODS We studied patients with objectively confirmed GERD and persistent moderate to severe GERD symptoms without PPI therapy. Of 121 patients screened, we finally randomised 44 patients with 22 patients in each group. Those allocated to TIF had the TIF2 procedure completed during general anaesthesia by the EsophyX device with SerosaFuse fasteners. The sham procedure consisted of upper GI endoscopy under general anaesthesia. Neither the patient nor the assessor was aware of the patients' group affiliation. The primary effectiveness endpoint was the proportion of patients in clinical remission after 6-month follow-up. Secondary outcomes were: PPI consumption, oesophageal acid exposure, reduction in Quality of Life in Reflux and Dyspepsia and Gastrointestinal Symptom Rating Scale scores and healing of reflux esophagitis. RESULTS The time (average days) in remission offered by the TIF2 procedure (197) was significantly longer compared to those submitted to the sham intervention (107), P < 0.001. After 6 months 13/22 (59%) of the chronic GERD patients remained in clinical remission after the active intervention. Likewise, the secondary outcome measures were all in favour of the TIF2 procedure. No safety issues were raised. CONCLUSION Transoral incisionless fundoplication (TIF2) is effective in chronic PPI-dependent GERD patients when followed up for 6 months. Clinicaltrials.gov: CT01110811.
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Affiliation(s)
- B Håkansson
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - M Montgomery
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - G B Cadiere
- Department of Surgery and Gastroenterology, Park Leopold Clinic, CHIREC, Brussels, Belgium
| | - A Rajan
- Department of Surgery and Gastroenterology, Park Leopold Clinic, CHIREC, Brussels, Belgium
| | | | - M Lerhun
- CHU Hotel Dieu Institut des Maladies de l' Appareil Digestif, Nantes, France
| | - E Coron
- CHU Hotel Dieu Institut des Maladies de l' Appareil Digestif, Nantes, France
| | - J Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - R Bischops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - A Thorell
- Department of Surgery, Ersta Hospital, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
| | - U Arnelo
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Huddinge Hospital, Karolinska Institutet, Stockholm, Sweden
| | - L Lundell
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Huddinge Hospital, Karolinska Institutet, Stockholm, Sweden
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Hunter JG, Kahrilas PJ, Bell RCW, Wilson EB, Trad KS, Dolan JP, Perry KA, Oelschlager BK, Soper NJ, Snyder BE, Burch MA, Melvin WS, Reavis KM, Turgeon DG, Hungness ES, Diggs BS. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology 2015; 148:324-333.e5. [PMID: 25448925 DOI: 10.1053/j.gastro.2014.10.009] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Transoral esophagogastric fundoplication (TF) can decrease or eliminate features of gastroesophageal reflux disease (GERD) in some patients whose symptoms persist despite proton pump inhibitor (PPI) therapy. We performed a prospective, sham-controlled trial to determine if TF reduced troublesome regurgitation to a greater extent than PPIs in patients with GERD. METHODS We screened 696 patients with troublesome regurgitation despite daily PPI use with 3 validated GERD-specific symptom scales, on and off PPIs. Those with at least troublesome regurgitation (based on the Montreal definition) on PPIs underwent barium swallow, esophagogastroduodenoscopy, 48-hour esophageal pH monitoring (off PPIs), and high-resolution esophageal manometry analyses. Patients with GERD and hiatal hernias ≤2 cm were randomly assigned to groups that underwent TF and then received 6 months of placebo (n = 87), or sham surgery and 6 months of once- or twice-daily omeprazole (controls, n = 42). Patients were blinded to therapy during follow-up period and reassessed at 2, 12, and 26 weeks. At 6 months, patients underwent 48-hour esophageal pH monitoring and esophagogastroduodenoscopy. RESULTS By intention-to-treat analysis, TF eliminated troublesome regurgitation in a larger proportion of patients (67%) than PPIs (45%) (P = .023). A larger proportion of controls had no response at 3 months (36%) than subjects that received TF (11%; P = .004). Control of esophageal pH improved after TF (mean 9.3% before and 6.3% after; P < .001), but not after sham surgery (mean 8.6% before and 8.9% after). Subjects from both groups who completed the protocol had similar reductions in GERD symptom scores. Severe complications were rare (3 subjects receiving TF and 1 receiving the sham surgery). CONCLUSIONS TF was an effective treatment for patients with GERD symptoms, particularly in those with persistent regurgitation despite PPI therapy, based on evaluation 6 months after the procedure. Clinicaltrials.gov no: NCT01136980.
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Affiliation(s)
- John G Hunter
- Department of Surgery, Oregon Health & Science University, Portland, Oregon.
| | - Peter J Kahrilas
- Department of Surgery and Department of Gastroenterology, Northwestern University, Chicago, Illinois
| | | | - Erik B Wilson
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Karim S Trad
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Reston Surgical Associates, Reston, Virginia
| | - James P Dolan
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Kyle A Perry
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | | | - Nathaniel J Soper
- Department of Surgery and Department of Gastroenterology, Northwestern University, Chicago, Illinois
| | - Brad E Snyder
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Miguel A Burch
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Kevin M Reavis
- Department of Surgery, Oregon Health & Science University, Portland, Oregon; Department of Surgery, Oregon Clinic, Portland, Oregon
| | - Daniel G Turgeon
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia; Reston Surgical Associates, Reston, Virginia
| | - Eric S Hungness
- Department of Surgery and Department of Gastroenterology, Northwestern University, Chicago, Illinois
| | - Brian S Diggs
- Department of Surgery, Oregon Health & Science University, Portland, Oregon
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Long-term cost-effectiveness of medical, endoscopic and surgical management of gastroesophageal reflux disease. Surgery 2014; 157:126-36. [PMID: 25262216 DOI: 10.1016/j.surg.2014.05.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/30/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The long-term cost effectiveness of medical, endoscopic, and operative treatments for adults with gastroesophageal reflux disease (GERD) remains unclear. We sought to estimate the cost effectiveness of medical, endoscopic, and operative treatments for adults with GERD who require daily proton pump inhibitor (PPI) therapy. METHODS A Markov model was generated from the payer's perspective using a 6-month cycle and 30-year time horizon. The base-case patient was a 45-year-old man with symptomatic GERD taking 20 mg of omeprazole twice daily. Four treatment strategies were analyzed: PPI therapy, transoral incisionless fundoplication (EsophyX), radiofrequency energy application to the lower esophageal sphincter (Stretta) and laparoscopic Nissen fundoplication. The model parameters were selected using the published literature and institutional billing data. The main outcome measure was the incremental cost-effectiveness ratio (cost per quality-adjusted life-year gained) for each therapy. RESULTS In the base case analysis, which assumed a PPI cost of $234 over 6 months ($39 per month), Stretta and laparoscopic Nissen fundoplication were the most cost-effective options over a 30-year time period ($2,470.66 and $5,579.28 per QALY gained, respectively). If the cost of PPI therapy exceeded $90.63 per month over 30 years, laparoscopic Nissen fundoplication became the dominant treatment option. EsophyX was dominated by laparoscopic Nissen fundoplication at all points in time. CONCLUSION Low-cost PPIs, Stretta, and laparoscopic Nissen fundoplication all represent cost-effective treatment strategies. In this model, when PPIs exceed $90 per month, medical therapy is no longer cost effective. Procedural GERD therapy should be considered for patients who require high-dose or expensive PPIs.
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Elective antireflux surgery in the US: an analysis of national trends in utilization and inpatient outcomes from 2005 to 2010. Surg Endosc 2014; 28:1712-9. [DOI: 10.1007/s00464-013-3380-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
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Halverson AL, Hughes TG, Borgstrom DC, Sachdeva AK, DaRosa DA, Hoyt DB. What Surgical Skills Rural Surgeons Need to Master. J Am Coll Surg 2013; 217:919-23. [DOI: 10.1016/j.jamcollsurg.2013.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 05/25/2013] [Accepted: 06/28/2013] [Indexed: 11/27/2022]
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Niebisch S, Fleming FJ, Galey KM, Wilshire CL, Jones CE, Litle VR, Watson TJ, Peters JH. Perioperative risk of laparoscopic fundoplication: safer than previously reported-analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2009. J Am Coll Surg 2012; 215:61-8; discussion 68-9. [PMID: 22578304 DOI: 10.1016/j.jamcollsurg.2012.03.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 03/05/2012] [Accepted: 03/28/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Several prospective randomized controlled trials show equal effectiveness of surgical fundoplication and proton pump inhibitor therapy for the treatment of gastroesophageal reflux disease. Despite this compelling evidence of its efficacy, surgical antireflux therapy is underused, occurring in a very small proportion of patients with gastroesophageal reflux disease. An important reason for this is the perceived morbidity and mortality associated with surgical intervention. Published data report perioperative morbidity between 3% and 21% and mortality of 0.2% and 0.5%, and current data are uncommon, largely from previous decades, and almost exclusively single institutional. STUDY DESIGN The study population included all patients in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 through 2009 who underwent laparoscopic fundoplication with or without related postoperative ICD-9 codes. Comorbidities, intraoperative occurrences, and 30-day postoperative outcomes were collected and logged into statistical software for appropriate analysis. Postoperative occurrences were divided into overall and serious morbidity. RESULTS A total of 7,531 fundoplications were identified. Thirty-five percent of patients were younger than 50 years old, 47.1% were 50 to 69 years old, and 16.8% were older than 69 years old. Overall, 30-day mortality was 0.19% and morbidity was 3.8%. Thirty-day mortality was rare in patients younger than age 70 years, occurring in 5 of 10,000 (0.05%). Mortality increased to 8 of 1,000 (0.8%) in patients older than 70 years (p < 0.0001). Complications occurred in 2.2% of patients younger than 50 years, 3.8% of those 50 to 69 years, and 7.3% of patients older than 69 years. Serious complications occurred in 8 of 1,000 (0.8%) patients younger than 50 years, 1.8% in patients 50 to 69 years, and 3.9% of those older than 69 years. CONCLUSIONS Analysis of this large cohort demonstrates remarkably low 30-day morbidity and mortality of laparoscopic fundoplication. This is particularly true in patients younger than 70 years, who are likely undergoing fundoplication for gastroesophageal reflux disease. These data suggest that surgical therapy carries an acceptable risk profile.
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Affiliation(s)
- Stefan Niebisch
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
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Birkmeyer JD. Improving the quality of minimally invasive surgery. Surg Innov 2005; 11:269-70. [PMID: 15756397 DOI: 10.1177/155335060401100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Gastroesophageal reflux disease is a very common disorder, and both medical and surgical treatments have shown outstanding results. Whereas proton pump inhibitors are the mainstay of treatment, laparoscopic fundoplication has become a very attractive alternative due to its efficacy and low morbidity. There are defined patient categories that may benefit more from laparoscopy than medical therapy, but a conclusive comparison between the two is lacking. Robotic laparoscopic fundoplication can be performed safely without increased morbidity. Potential advantages include enhanced precision, improved dexterity, and remote telesurgical applications. Disadvantages include increased cost and prolonged operative times. Further studies and more long-term outcome data are needed to fully evaluate the procedure. Robotic surgery is currently in its infancy and not cost effective but has a very promising future. With further development of automatization and miniaturization features, robotic surgery may prove more efficient than conventional laparoscopy.
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Affiliation(s)
- Dimitrios Stefanidis
- Tulane Center for Minimally Invasive Surgery, Tulane University Health Sciences Center, 1430 Tulane Ave., SL-22, New Orleans, LA 70112-2699, USA..
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