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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] [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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Li G, Jiang N, Chendaer N, Hao Y, Zhang W, Peng C. Laparoscopic Nissen Versus Toupet Fundoplication for Short- and Long-Term Treatment of Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review. Surg Innov 2023; 30:745-757. [PMID: 36998190 PMCID: PMC10656788 DOI: 10.1177/15533506231165829] [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] [Indexed: 04/01/2023]
Abstract
BACKGROUND Laparoscopic Nissen fundoplication (LNF) is the most common standard technique worldwidely for Gastroesophageal reflux disease (GERD). Another type of fundoplication, laparoscopic Toupet fundoplication (LTF), intends to reduce incidence of postoperative complications. A systematic review and meta-analysis are required on short- and long-term outcomes based on randomized controlled trials (RCTs) between LNF and LTF. METHODS We searched databases including PubMed, Cochrane, Embase, and Web of Knowledge for RCTs comparing LNF and LTF. Outcomes included postoperative reflux recurrence, postoperative heartburn, dysphagia and postoperative chest pain, inability to belch, gas bloating, satisfaction with intervention, postoperative esophagitis, postoperative DeMeester scores, operating time (min), in-hospital complications, postoperative use of proton pump inhibitors, reoperation rate, postoperative lower oesophageal sphincter (LOS) pressure (mmHg). We assessed data using risk ratios and weighted mean differences in meta-analyses. RESULTS Eight eligible RCTs comparing LNF (n = 605) and LTF (n = 607) were identified. There were no significant differences between the LNF and LTF in terms of postoperative reflux recurrence, postoperative heartburn, postoperative chest pain, satisfaction with intervention, reoperation rate in short and long term, in-hospital complications, esophagitis in short term, and gas bloating, postoperative DeMeester scores, postoperative use of proton pump inhibitors, reoperation rate in long term. LTF had lower LOS pressure (mmHg), fewer postoperative dysphagia and inability to belch in short and long term and gas bloating in short term compared to LNF. CONCLUSION LTF were equally effective at controlling reflux symptoms and improving the quality of life, but with lower rate of complications compared to LNF. We concluded that LTF surgical treatment was superior for over 16 years old patients with typical symptoms of GERD and without upper abdominal surgical history upon high-level evidence of evidence-based medicine.
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Affiliation(s)
- Gen Li
- Department of Thoracic Surgery, The Second Hospital of Shandong University
| | - Ning Jiang
- Department of Thoracic Surgery, The Second Hospital of Shandong University
| | - Nuerboli Chendaer
- Department of Thoracic Surgery, The Second Hospital of Shandong University
| | - Yingtao Hao
- Department of Thoracic Surgery, The Second Hospital of Shandong University
| | - Weiquan Zhang
- Department of Thoracic Surgery, The Second Hospital of Shandong University
| | - Chuanliang Peng
- Department of Thoracic Surgery, The Second Hospital of Shandong University
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Paranyak M, Patel R. A prospective randomized trial on laparoscopic total vs partial fundoplication in patients with atypical symptoms of gastroesophageal reflux disease. Langenbecks Arch Surg 2023; 408:269. [PMID: 37421502 DOI: 10.1007/s00423-023-03013-0] [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: 03/12/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Currently very little is known about the impact of anti-reflux surgery on extra-esophageal manifestations of gastroesophageal reflux disease (GERD) when compared with the typical symptoms of reflux. The aim of our study was to evaluate the clinical effect of total (360°) and partial (270°) laparoscopic fundoplication on extraesophageal GERD symptoms. METHODS One hundred and twenty patients with documented extraesophageal GERD symptoms were randomized to either undergo floppy Nissen (n= 60) or Toupet fundoplication (n= 60). Symptom scores of throat clearing, globus sensation, cough, throat pain, and vocal changes were prospectively evaluated. A reflux symptom index (RSI) questionnaire was used to accurately document the improvement of extraesophageal symptoms. Quality of life was determined according to the laryngopharyngeal reflux-health-related quality of life (LPR-HRQL) questionnaire. RESULTS No significant differences were identified between the groups regarding demographic data, such as age, gender, or body mass index. The median RSI score before operation and at 24-month follow-up was 22.8 ± 5.3 and 10.4 ± 5.4 respectively in the laparoscopic Nissen fundoplication (LNF) group (p < 0.05) and 21.7 ± 5.0 and 11.6 ± 5 respectively in the laparoscopic Toupet fundoplication (LTF) group (p < 0.05). The median LPR-HRQL score in the LNF group improved from 42.9 ± 13.8 before treatment to 10.7 ± 6.5 at 24 months (p < 0.05). In the LTF group, there was an improvement in the median LPR-HRQL score from 40.4 ± 10.9 prior to treatment to 11.7 ± 5.7 at 24 months (p < 0.05). The median RSI score and LPR-HRQL scores were similar between the groups at follow-up (p > 0.05). CONCLUSIONS Our report demonstrates that LNF and LTF provide equivalently good results for patients with extraesophageal manifestations of GERD. Quality of life is similar after LNF and LTF.
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Affiliation(s)
- Mykola Paranyak
- Department of General Surgery, Danylo Halytsky Lviv National Medical University, 69 Pekarska str, Lviv, 79010, Ukraine.
| | - Rikesh Patel
- Liverpool University Hospitals Foundation Trust, Liverpool, England, UK
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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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5
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Slater BJ, Collings A, Dirks R, Gould JC, Qureshi AP, Juza R, Rodríguez-Luna MR, Wunker C, Kohn GP, Kothari S, Carslon E, Worrell S, Abou-Setta AM, Ansari MT, Athanasiadis DI, Daly S, Dimou F, Haskins IN, Hong J, Krishnan K, Lidor A, Litle V, Low D, Petrick A, Soriano IS, Thosani N, Tyberg A, Velanovich V, Vilallonga R, Marks JM. Multi-society consensus conference and guideline on the treatment of gastroesophageal reflux disease (GERD). Surg Endosc 2023; 37:781-806. [PMID: 36529851 DOI: 10.1007/s00464-022-09817-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is one of the most common diseases in North America and globally. The aim of this guideline is to provide evidence-based recommendations regarding the most utilized and available endoscopic and surgical treatments for GERD. METHODS Systematic literature reviews were conducted for 4 key questions regarding the surgical and endoscopic treatments for GERD in adults: preoperative evaluation, endoscopic vs surgical or medical treatment, complete vs partial fundoplication, and treatment for obesity (body mass index [BMI] ≥ 35 kg/m2) and concomitant GERD. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed. RESULTS The consensus provided 13 recommendations. Through the development of these evidence-based recommendations, an algorithm was proposed for aid in the treatment of GERD. Patients with typical symptoms should undergo upper endoscopy, manometry, and pH-testing; additional testing may be required for patients with atypical or extra-esophageal symptoms. Patients with normal or abnormal findings on manometry should consider undergoing partial fundoplication. Magnetic sphincter augmentation or fundoplication are appropriate surgical procedures for adults with GERD. For patients who wish to avoid surgery, the Stretta procedure and transoral incisionless fundoplication (TIF 2.0) were found to have better outcomes than proton pump inhibitors alone. Patients with concomitant obesity were recommended to undergo either gastric bypass or fundoplication, although patients with severe comorbid disease or BMI > 50 should undergo Roux-en-Y gastric bypass for the additional benefits that follow weight loss. CONCLUSION Using the recommendations an algorithm was developed by this panel, so that physicians may better counsel their patients with GERD. There are certain patient factors that have been excluded from included studies/trials, and so these recommendations should not replace surgeon-patient decision making. Engaging in the identified research areas may improve future care for GERD patients.
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Affiliation(s)
- Bethany J Slater
- University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, USA.
| | - Amelia Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alia P Qureshi
- Division of General & GI Surgery, Foregut Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Ryan Juza
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - María Rita Rodríguez-Luna
- Research Institute Against Digestive Cancer (IRCAD) and ICube Laboratory, Photonics Instrumentation for Health, Strasbourg, France
| | | | - Geoffrey P Kohn
- Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Shanu Kothari
- Department of Surgery, Prisma Health, Greenville, SC, USA
| | | | | | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Shaun Daly
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | | | - Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, USA
| | - Julie Hong
- Department of Surgery, New York Presbyterian/Queens, Queens, USA
| | | | - Anne Lidor
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Virginia Litle
- Section of Thoracic Surgery, Department of Cardiovascular Surgery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Donald Low
- Virginia Mason Medical Center, Seattle, WA, USA
| | - Anthony Petrick
- Department of General Surgery, Geisinger School of Medicine, Geisinger Medical Center, Danville, PA, USA
| | - Ian S Soriano
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Nirav Thosani
- McGovern Medical School, Center for Interventional Gastroenterology at UTHealth, Houston, TX, USA
| | - Amy Tyberg
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vic Velanovich
- Division of Gastrointestinal Surgery, Tampa General, Tampa, FL, USA
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeffrey M Marks
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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6
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Rausa E, Ferrari D, Kelly ME, Aiolfi A, Vitellaro M, Rottoli M, Bonitta G, Bona D. Efficacy of laparoscopic Toupet fundoplication compared to endoscopic and surgical procedures for GERD treatment: a randomized trials network meta-analysis. Langenbecks Arch Surg 2023; 408:52. [PMID: 36680602 DOI: 10.1007/s00423-023-02774-y] [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: 10/10/2022] [Accepted: 12/27/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE We aim to review and quantitatively compare laparoscopic Toupet fundoplication (LTF), Nissen fundoplication (LNF), anterior partial fundoplication (APF), magnetic augmentation sphincter (MSA), radiofrequency ablation (RFA), transoral incisionless fundoplication (TIF), proton pump inhibitor (PPI), and placebo for the treatment of GERD. A number of meta-analyses compared the efficacy of surgical and endoscopic procedures for recalcitrant GERD, but considerable debate on the effectiveness of operative strategies remains. METHODS A systematic review of MEDLINE databases, EMBASE, and Web of Science for randomized controlled trials (RCTs) comparing the aforementioned surgical and endoscopic GERD treatments was performed. Risk ratio and weighted mean difference were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to assess relative inference. RESULTS Thirty-three RCTs were included. Surgical and endoscopic treatments have similar RR for heartburn, regurgitation, bloating. LTF has a lower RR of post-operative dysphagia when compared to APF (RR 3.3; Crl 1.4-7.1) and LNF (RR 2.5; Crl 1.3-4.4). The pooled network meta-analysis did not observe any significant improvement regarding LES pressure and pH < from baseline. LTF, APF, LNF, MSA, RFA, and TIF had have a similar post-operative PPI discontinuation rate. CONCLUSION LTF has a lower rate of post-operative dysphagia when compared to APF and LNF. The pre-post effects, such as GERD-HQRL, LES pressure, and pH <4, should be avoided in meta-analyses because results may be biased. Last, a consensus about the evaluation of GERD treatments' efficacy and their outcomes is needed.
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Affiliation(s)
- E Rausa
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - D Ferrari
- General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M E Kelly
- Department of Surgery, St. James Hospital, School of Medicine-Trinity College Dublin, Dublin, Ireland
| | - A Aiolfi
- General Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - Marco Vitellaro
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - M Rottoli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - G Bonitta
- General Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | - D Bona
- General Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy
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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] [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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8
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Schuitenmaker JM, van Hoeij FB, Schijven MP, Tack J, Conchillo JM, Hazebroek EJ, Smout AJPM, Bredenoord AJ. Pneumatic dilation for persistent dysphagia after antireflux surgery, a multicentre single-blind randomised sham-controlled clinical trial. Gut 2022; 71:10-15. [PMID: 33452179 DOI: 10.1136/gutjnl-2020-322355] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE There is no evidence-based treatment for persistent dysphagia after laparoscopic fundoplication. The aim of this study was to evaluate the effect of pneumatic dilation on persistent dysphagia after laparoscopic fundoplication. DESIGN We performed a multicentre, single-blind, randomised sham-controlled trial of patients with persistent dysphagia (>3 months) after laparoscopic fundoplication. Patients with an Eckardt symptom score ≥4 were randomly assigned to pneumatic dilation (PD) using a 35 mm balloon or sham dilation. Primary outcome was treatment success, defined as an Eckardt score <4 and a minimal reduction of 2 points in the Eckardt score after 30 days. Secondary outcomes included change in stasis on timed barium oesophagogram, change in high-resolution manometry parameters and questionnaires on quality of life, reflux and dysphagia symptoms. RESULTS Forty-two patients were randomised. In the intention-to-treat analysis, the success rates of PD (7/21 patients (33%)) and sham dilation (8/21 patients (38%)) were similar after 30 days (risk difference -4.7% (95% CI (-33.7% to 24.2%) p=0.747). There was no significant difference in change of stasis on the timed barium oesophagogram after 2 min (PD vs sham: median 0.0 cm, p25-p75 range 0.0-4.3 cm vs median 0.0 cm, p25-p75 range 0.0-0.0; p=0.122) or change in lower oesophageal sphincter relaxation pressure (PD vs sham: 10.54±6.25 vs 14.60±6.17 mm Hg; p=0.052). Quality of life, reflux and dysphagia symptoms were not significantly different between the two groups. CONCLUSION Pneumatic dilation with a 35 mm balloon is not superior to sham dilation for the treatment of persistent dysphagia after fundoplication.
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Affiliation(s)
- Jeroen M Schuitenmaker
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Froukje B van Hoeij
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Jan Tack
- Department of Gastroenterology and Hepatology, KU Leuven University Hospitals, Leuven, Belgium
| | - José M Conchillo
- Department of Gastroenterology and Hepatology, Maastricht UMC+, Maastricht, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - André J P M Smout
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
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9
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Kuvendjiska J, Höppner J. [Mesh Implantation in Anti-Reflux and Hiatal Hernia Surgery - Contra Statement]. Zentralbl Chir 2021; 146:200-203. [PMID: 33851382 DOI: 10.1055/a-1403-3558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In the surgical treatment of gastroesophageal reflux disease and of hiatal hernias, the high rate of recurrence of hiatal hernias is a central problem. Against this background, various, primarily alloplastic, meshes are used to augment suture closure on the esophageal hiatus. Very different results have been reported in the past and the use of meshes in hiatus reconstruction is controversial. In addition to the frequency of recurrences, reports about complications of mesh augmentation are in the foreground. On the basis of several prospective randomised double-blinded comparative studies and meta-analyses (class Ia and Ib evidence), the current data do not show any advantages of mesh-augmented hiatoplasty for the prevention of recurrence of hiatal hernia. At the same time, there exist reports of more long-term postoperative complications, especially dysphagia, after use of meshes for augmentation of hiatus reconstruction. Therefore, routine use of mesh augmentation for hiatus reconstruction is currently not recommended.
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Affiliation(s)
- Jasmina Kuvendjiska
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Deutschland
| | - Jens Höppner
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland
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10
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McKinley SK, Dirks RC, Walsh D, Hollands C, Arthur LE, Rodriguez N, Jhang J, Abou-Setta A, Pryor A, Stefanidis D, Slater BJ. Surgical treatment of GERD: systematic review and meta-analysis. Surg Endosc 2021; 35:4095-4123. [PMID: 33651167 DOI: 10.1007/s00464-021-08358-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) has a high worldwide prevalence in adults and children. There is uncertainty regarding medical versus surgical therapy and different surgical techniques. This review assessed outcomes of antireflux surgery versus medical management of GERD in adults and children, robotic versus laparoscopic fundoplication, complete versus partial fundoplication, and minimal versus maximal dissection in pediatric patients. METHODS PubMed, Embase, and Cochrane databases were searched (2004-2019) to identify randomized control and non-randomized comparative studies. Two independent reviewers screened for eligibility. Random effects meta-analysis was performed on comparative data. Study quality was assessed using the Cochrane Risk of Bias and Newcastle Ottawa Scale. RESULTS From 1473 records, 105 studies were included. Most had high or uncertain risk of bias. Analysis demonstrated that anti-reflux surgery was associated with superior short-term quality of life compared to PPI (Std mean difference = - 0.51, 95%CI - 0.63, - 0.40, I2 = 0%) however short-term symptom control was not significantly superior (RR = 0.75, 95%CI 0.47, 1.21, I2 = 82%). A proportion of patients undergoing operative treatment continue PPI treatment (28%). Robotic and laparoscopic fundoplication outcomes were similar. Compared to total fundoplication, partial fundoplication was associated with higher rates of prolonged PPI usage (RR = 2.06, 95%CI 1.08, 3.94, I2 = 45%). There was no statistically significant difference for long-term symptom control (RR = 0.94, 95%CI 0.85, 1.04, I2 = 53%) or long-term dysphagia (RR = 0.73, 95%CI 0.52, 1.02, I2 = 0%). Ien, minimal dissection during fundoplication was associated with lower reoperation rates than maximal dissection (RR = 0.21, 95%CI 0.06, 0.67). CONCLUSIONS The available evidence regarding the optimal treatment of GERD often suffers from high risk of bias. Additional high-quality randomized control trials may further inform surgical decision making in the treatment of GERD.
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Affiliation(s)
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Danielle Walsh
- Walsh - Department of Surgery, East Carolina University, Greenville, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Lauren E Arthur
- Walsh - Department of Surgery, East Carolina University, Greenville, USA
| | - Noe Rodriguez
- Department of Surgery, Florida Atlantic University, Boca Raton, USA
| | - Joyce Jhang
- University of Nebraska Medical Center, Omaha, USA
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | | | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, 606037, USA.
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Sharma P, Yadlapati R. Pathophysiology and treatment options for gastroesophageal reflux disease: looking beyond acid. Ann N Y Acad Sci 2020; 1486:3-14. [PMID: 33015827 DOI: 10.1111/nyas.14501] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a disorder due to the retrograde flow of refluxate into the esophagus. Although GERD is a common clinical diagnosis, its pathogenesis is quite complex. As a result of its multifactorial development, many patients continue to experience adverse symptoms due to GERD despite prolonged acid suppression with proton pump inhibitor therapy. The pathogenesis of GERD involves an interplay of chemical, mechanical, psychologic, and neurologic mechanisms, which contribute to symptom presentation, diagnosis, and treatment. As such, GERD should be approached as a disorder beyond acid. This review will investigate the major factors that contribute to the development of GERD, including factors related to the refluxate, esophageal defenses, and factors that promote pathologic reflux into the esophagus. In reviewing GERD pathogenesis, this paper will highlight therapeutic advances, with mention of future opportunities of study when approaching GERD.
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Affiliation(s)
- Priya Sharma
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, California
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego School of Medicine, Center for Esophageal Diseases, La Jolla, California
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Andreou A, Watson DI, Mavridis D, Francis NK, Antoniou SA. Assessing the efficacy and safety of laparoscopic antireflux procedures for the management of gastroesophageal reflux disease: a systematic review with network meta-analysis. Surg Endosc 2020; 34:510-520. [PMID: 31628621 DOI: 10.1007/s00464-019-07208-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite the extensive literature on laparoscopic antireflux surgery, comparative evidence across different procedures is scarce. The aim of this study was to assess and rank the most efficacious and safe laparoscopic procedures for the management of gastroesophageal reflux disease. METHODS Medline, Embase, AMED, CINAHL, CENTRAL, and OpenGrey databases were queried for randomized trials comparing two or more laparoscopic antireflux procedures with each other or with medical treatment for the management of gastroesophageal reflux disease. Pairwise meta-analyses were conducted for each pair of interventions using a random-effects model. Network meta-analysis was employed to assess the relative efficacy and safety of laparoscopic antireflux procedures for the management of gastroesophageal reflux disease. RESULTS Forty-four publications reporting 29 randomized trials which included 1892 patients were identified. The network of treatments was sparse with only a closed loop between different types of wraps; 270°, 360°, anterior 180° and anterior 90°; and star network between 360° and other treatments; and between anterior 180° and other treatments. Laparoscopic 270° (odds ratio, OR 1.19, 95% confidence interval, CI 0.64-2.22), anterior 180°, and anterior 90° were equally effective as 360° for control of heartburn, although this finding was supported by low quality of evidence according to GRADE modification for NMA. The odds for dysphagia were lower after 270° (OR 0.38, 95%, CI 0.24-0.60), anterior 90° (moderate quality evidence), and anterior 180° (low-quality evidence) compared to 360°. The odds for gas-bloat were lower after 270° (OR 0.51, 95% CI 0.27, 0.95) and after anterior 90° compared to 360° (low-quality evidence). Regurgitation, morbidity, and reoperation were similar across treatments, albeit these were associated with very low-quality evidence. CONCLUSION Laparoscopic 270° fundoplication achieves a better outcome than 360° total fundoplication, especially in terms of postoperative dysphagia, although other types of partial fundoplication might be equally effective. REGISTRATION NO CRD42017074783.
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Affiliation(s)
- Alexandros Andreou
- Upper GI Department, Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, UK
| | - David I Watson
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, Australia
| | - Dimitrios Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | - Stavros A Antoniou
- Department of Surgery, European University Cyprus, Nicosia, Cyprus.
- Department of Surgery, Mediterranean Hospital of Cyprus, Limassol, Cyprus.
- , Athens, Greece.
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A retrospective multicenter analysis on redo-laparoscopic anti-reflux surgery: conservative or conversion fundoplication? Surg Endosc 2019; 33:243-251. [PMID: 29943063 DOI: 10.1007/s00464-018-6304-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Nearly 20% of patients who undergo hiatal hernia (HH) repair and anti-reflux surgery (ARS) report recurrent HH at long-term follow-up and may be candidates for redo surgery. Current literature on redo-ARS has limitations due to small sample sizes or single center experiences. This type of redo surgery is challenging due to rare but severe complications. Furthermore, the optimal technique for redo-ARS remains debatable. The purpose of the current multicenter study was to review the outcomes of redo-fundoplication and to identify the best ARS repair technique for recurrent HH and gastroesophageal reflux disease (GERD). METHODS Data on 975 consecutive patients undergoing hiatal hernia and GERD repair were retrospectively collected in five European high-volume centers. Patient data included demographics, BMI, techniques of the first and redo surgeries (mesh/type of ARS), perioperative morbidity, perioperative complications, duration of hospitalization, time to recurrence, and follow-up. We analyzed the independent risk factors associated with recurrent symptoms and complications during the last ARS. Statistical analysis was performed using GraphPad Prism® and R software®. RESULTS Seventy-three (7.49%) patients underwent redo-ARS during the last decade; 71 (98%) of the surgeries were performed using a minimally invasive approach. Forty-two (57.5%) had conversion from Nissen to Toupet. In 17 (23.3%) patients, the initial Nissen fundoplication was conserved. The initial Toupet fundoplication was conserved in 9 (12.3%) patients, and 5 (6.9%) had conversion of Toupet to Nissen. Out of the 73 patients, 10 (13%) underwent more than one redo-ARS. At 8.5 (1-107) months of follow-up, patients who underwent reoperation with Toupet ARS were less symptomatic during the postoperative period compared to those who underwent Nissen fundoplication (p = 0.005, OR 0.038). Patients undergoing mesh repair during the redo-fundoplication (21%) were less symptomatic during the postoperative period (p = 0.020, OR 0.010). The overall rate of complications (Clavien-Dindo classification) after redo surgery was 11%. Multivariate analysis showed that the open approach (p = 0.036, OR 1.721), drain placement (p = 0.0388, OR 9.308), recurrence of dysphagia (p = 0.049, OR 8.411), and patient age (p = 0.0619, OR 1.111) were independent risk factors for complications during the last ARS. CONCLUSIONS Failure of ARS rarely occurs in the hands of experienced surgeons. Redo-ARS is feasible using a minimally invasive approach. According to our study, in terms of recurrence of symptoms, Toupet fundoplication is a superior ARS technique compared to Nissen for redo-fundoplication. Therefore, Toupet fundoplication should be considered in redo interventions for patients who initially underwent ARS with Nissen fundoplication. Furthermore, mesh repair in reoperations has a positive impact on reducing the recurrence of symptoms postoperatively.
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Walle KV, Funk LM, Xu Y, Davies KD, Greenberg J, Shada A, Lidor A. Persistent Dysphagia Rate After Antireflux Surgery is Similar for Nissen Fundoplication and Partial Fundoplication. J Surg Res 2018; 235:52-57. [PMID: 30691837 DOI: 10.1016/j.jss.2018.09.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/06/2018] [Accepted: 09/11/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Laparoscopic fundoplication is the gold standard operation for treatment of gastroesophageal reflux disease (GERD). It has been suggested that persistent postoperative dysphagia is increased following Nissen fundoplication compared to partial fundoplication. This study aimed to determine risk factors for persistent postoperative dysphagia, specifically examining the type of fundoplication. METHODS Patients experiencing GERD symptoms who underwent laparoscopic Nissen, Toupet, or Dor fundoplication from 2009 to 2016 were identified from a single-institutional database. A dysphagia score was obtained as part of the GERD health-related quality of life questionnaire. Persistent dysphagia was defined as a difficulty swallowing score ≥1 (noticeable) on a scale from 0 to 5 at least 1 y postoperatively. Odds ratios of persistent dysphagia among those who underwent antireflux surgery were calculated in a multivariate logistic regression model adjusted for fundoplication type, sex, age, body mass index, and redo operation. RESULTS Of the 441 patients who met inclusion criteria, 255 had ≥1 y of follow-up (57.8%). The median duration of follow-up was 3 y. In this cohort, 45.1% of patients underwent Nissen fundoplication and 54.9% underwent partial fundoplication. Persistent postoperative dysphagia was present in 25.9% (n = 66) of patients. On adjusted analysis, there was no statistically significant association between the type of fundoplication (Nissen versus partial) and the likelihood of postoperative dysphagia. CONCLUSIONS Persistent postoperative dysphagia after antireflux surgery occurred in approximately one-quarter of patients and did not differ by the type of fundoplication. These findings suggest that both Nissen and partial fundoplication are reasonable choices for an antireflux operation for properly selected patients.
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Affiliation(s)
- Kara Vande Walle
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin; Department of Surgery, William S. Middleton VA, Madison, Wisconsin
| | - Yiwei Xu
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin
| | - Kevin D Davies
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin
| | - Jacob Greenberg
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin
| | - Amber Shada
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin
| | - Anne Lidor
- Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin.
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Lung Transplantation in Connective Tissue Disease-Associated Interstitial Lung Disease (CTD-ILD). CURRENT PULMONOLOGY REPORTS 2018. [DOI: 10.1007/s13665-018-0207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, Mitsumori N, Kashiwagi H, Yanaga K. Comparison of laparoscopic Nissen and Toupet fundoplication using a propensity score matching analysis. Surg Today 2017; 47:1195-1200. [DOI: 10.1007/s00595-017-1490-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/31/2017] [Indexed: 01/01/2023]
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Zhang C, Wu J, Hu Z, Yan C, Gao X, Liang W, Liu D, Li F, Wang Z. Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring. PLoS One 2016; 11:e0160139. [PMID: 27532103 PMCID: PMC4988652 DOI: 10.1371/journal.pone.0160139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/14/2016] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Respiratory symptoms are often associated with gastroesophageal reflux disease (GERD). Although the role of multichannel intraluminal impedance–pH (MII-pH) monitoring in GERD is clear, little is known regarding the characteristics of patients with respiratory symptoms based on MII-pH monitoring and anti-reflux therapy. We evaluated a cohort of GERD patients to identify the MII-pH parameters of GERD-related respiratory symptoms and to assess the anti-reflux therapy outcomes. Methods We undertook a prospective study of patients who were referred for GERD evaluation from January 2011 to January 2012. One hundred ninety-five patients underwent MII-pH monitoring and esophageal manometry, and one hundred sixty-five patients underwent invasive anti-reflux therapy that included laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. The patient characteristics and MII-pH parameters were analyzed, and the symptom scores were assessed at baseline and at 1- and 3-year follow-up evaluations. Results Of the 195 patients, 96 (49.2%) exhibited respiratory symptoms and significantly more reflux episodes (70.7±29.3) than patients without respiratory symptoms (64.7±24.4, p = 0.044) based on the MII-pH monitoring results. Moreover, the group of patients with respiratory symptoms exhibited more proximal reflux episodes (35.2±21.3) than the non-respiratory symptomatic group (28.3±17.9, p = 0.013). One hundred twenty-five patients following the Stretta procedure (n = 60, 31 with respiratory symptoms) or LTF (n = 65, 35 with respiratory symptoms) completed the designated 3-year follow-up period and were included in the final analysis. The symptom scores after anti-reflux therapy all decreased relative to the corresponding baseline values (p<0.05), and there were no significant differences in the control of respiration between the Stretta procedure and LTF (p>0.05). However, LTF significantly reduced the recurrence (re-operation) rate compared with the Stretta procedure (0 vs. 19.4%, p = 0.006). Conclusions MII-pH monitoring effectively detected respiratory-related predictive parameters, including total/proximal reflux episodes and symptom correlations. We found that GERD patients with respiratory symptoms exhibited more proximal and total reflux episodes but not more acid-related episodes, as determined by MII-pH monitoring. Thus, such monitoring could be useful for diagnosing atypical GERD patients with respiratory symptoms. Furthermore, LTF exhibited a more significant effect on controlling typical symptoms in all GERD patients and reducing the recurrence rate than the Stretta procedure in patients with respiratory symptoms.
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Affiliation(s)
- Chao Zhang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
| | - Jimin Wu
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
| | - Zhiwei Hu
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
| | - Chao Yan
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiang Gao
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Weitao Liang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Diangang Liu
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Fei Li
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- * E-mail: (ZW); (FL)
| | - Zhonggao Wang
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
- Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People’s Liberation Army, No.16 Xinjiekou Street, Xicheng District, Beijing, 100088, China
- * E-mail: (ZW); (FL)
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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: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Liang WT, Yan C, Wang ZG, Wu JM, Hu ZW, Zhan XL, Wang F, Ma SS, Chen MP. Early and Midterm Outcome After Laparoscopic Fundoplication and a Minimally Invasive Endoscopic Procedure in Patients with Gastroesophageal Reflux Disease: A Prospective Observational Study. J Laparoendosc Adv Surg Tech A 2016; 25:657-61. [PMID: 26258269 DOI: 10.1089/lap.2015.0188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Although the minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage gastroesophageal reflux disease (GERD), the benefits of this procedure have to be further evaluated in clinical settings. This prospective observational study assessed the short-term and midterm outcomes associated with laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. PATIENTS AND METHODS From January 2011 to January 2012, we allocated 80 patients to LTF and 85 to the Stretta procedure. Primary outcome measures, including symptom scores of heartburn, regurgitation, chest pain, belching, hiccup, cough, and asthma, as well as proton pump inhibitor (PPI) use, were analyzed at midterm follow-up (1-3 years). RESULTS Of the 165 patients, 125 patients following LTF (n=65) or the Stretta procedure (n=60) completed the designated 3-year follow-up and were included in the final analysis. At the end of the 3-year follow-up, the symptom scores were all significantly decreased compared with the corresponding values before the two procedures in both groups (P<.05). After LTF and the Stretta procedure, 47/65 (72.3%) and 41/60 (68.3%) patients, respectively, achieved complete PPI therapy independence (72.3% versus 68.3%, P=.627). Comparing with LTF, however, the Stretta procedure had less effect on improving typical symptoms of heartburn, regurgitation, and chest pain and reducing the rate of re-operation (11.8% versus 0%, P=.006). CONCLUSIONS LTF and the Stretta procedure were equally effective in controlling GERD symptoms and reducing PPI use. However, LTF can achieve more improvement on typical symptoms and has a lower rate of re-operation.
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Affiliation(s)
- Wei-Tao Liang
- 1 Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University , Beijing, China
| | - Chao Yan
- 1 Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University , Beijing, China
| | - Zhong-Gao Wang
- 1 Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University , Beijing, China
| | - Ji-Min Wu
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Zhi-Wei Hu
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Xiu-Lan Zhan
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Feng Wang
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Song-Song Ma
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Mei-Ping Chen
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, 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] [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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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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