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Abouelella Y, Findlay JM. Systematic review of the perioperative classification, diagnosis, description and repair of hiatus hernias in randomized controlled trials. Dis Esophagus 2024:doae051. [PMID: 38944029 DOI: 10.1093/dote/doae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 07/01/2024]
Abstract
Hiatus hernias (HH) are a common cause of symptoms and complications, with considerable variation in anatomy, function, diagnosis and treatment. We undertook the first systematic review to appraise how HH are diagnosed and classified in the literature, using randomized controlled trials as a sample. A search was performed in July 2021of the PubMed, EMBASE and Cochrane Central Register of Controlled Trials, and 2832 articles were identified and 64 were included. Median Jadad score was 2. Studies demonstrated considerable variation in diagnosis, classification and minimum surgical steps. The commonest classifications before surgery were axial length and the Type I-IV classification, variably assessed by endoscopy and contrast swallow. Intra-operatively, the commonest classification was type I-IV. A minority used more than one classification, or alternatives such as defect size and Hill classification. Most studies reported minimum steps, but these varied. Only a minority reported criteria for diagnosing recurrence. Using randomized controlled trials to appraise the highest quality evidence in the literature, we found considerable variation and inconsistency in the way HH are diagnosed and classified. This lack of a 'common language' has significant impacts for the generalizability of evidence, study synthesis and design. We propose the development of an internationally accepted classification. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.
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Affiliation(s)
- Yasmin Abouelella
- North Devon Comprehensive Hernia Centre, Academic Department of Abdominal Wall and Upper Gastrointestinal Surgery, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Raleigh Heights, Barnstaple, Devon, EX31 4JB, UK
| | - John M Findlay
- North Devon Comprehensive Hernia Centre, Academic Department of Abdominal Wall and Upper Gastrointestinal Surgery, North Devon District Hospital, Royal Devon University Healthcare NHS Foundation Trust, Raleigh Heights, Barnstaple, Devon, EX31 4JB, UK
- Department of Clinical and Biomedical Sciences, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2Lu, UK
- NIHR Exeter Biomedical Research Centre, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
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2
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John M, Irvine T, Thompson SK, Bright T, Watson DI. Antireflux surgery in patients with gastroesophageal reflux but a negative 24-hour pH study: late outcomes. J Gastrointest Surg 2024:S1091-255X(24)00449-9. [PMID: 38735526 DOI: 10.1016/j.gassur.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Patients with gastroesophageal reflux disease often undergo a 24-hour pH test to confirm pathologic reflux before surgery. However, a negative pH test can occur in some individuals with reflux, and a case might still be made for antireflux surgery based on symptoms of reflux even in the absence of endoscopic esophagitis. The long-term outcomes in patients who underwent antireflux surgery despite negative preoperative test results were determined. METHODS Patients were selected from a prospective database. A total of 745 patients met the inclusion criteria, which included typical esophageal reflux symptoms, absence of a large hiatus hernia, preoperative 24-hour pH study performed, endoscopy, and postoperative symptom and satisfaction follow-up available at 5 years. Patients were divided into 3 groups based on 24-hour pH study and endoscopy results: negative pH and negative endoscopy (n = 65), negative pH and positive endoscopy (n = 72), and positive pH (n = 608). The negative pH and negative endoscopy group underwent surgery based on clinical assessment and typical esophageal reflux symptoms. Baseline and follow-up outcomes at 5 years were evaluated using 0 to 10 analog scores, which assessed heartburn, dysphagia, and satisfaction with the overall outcome. Data were analyzed to compare the groups. RESULTS The groups were well matched for demographics and preoperative symptom scores. At the median 5-year follow-up, clinical outcome scores were similar among the groups for heartburn, dysphagia, and overall satisfaction. The mean heartburn scores were 1.80 in the negative pH and negative endoscopy group, 1.88 in the negative pH and positive endoscopy group, and 1.91 in the positive pH group (P = .663). The mean satisfaction scores were high in all groups: 8.13, 7.31, and 7.72, respectively (P = .293). CONCLUSION No difference in clinical outcome scores was observed. The negative pH and negative endoscopy group had high satisfaction scores and low heartburn and dysphagia scores. Our findings support antireflux surgery in well-selected symptomatic patients with a negative preoperative pH test.
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Affiliation(s)
- Midhun John
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Tanya Irvine
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia; Department of Surgery, Flinders Medical Centre, South Australia, Australia
| | - Sarah K Thompson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Tim Bright
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia; Department of Surgery, Flinders Medical Centre, South Australia, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia; Department of Surgery, Flinders Medical Centre, South Australia, Australia.
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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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Nurminen NMJ, Järvinen TKM, Kytö VJ, Salo SAS, Egan CE, Andersson SE, Räsänen JV, Ilonen IKP. Malpractice claims after antireflux surgery and paraesophageal hernia repair: a population-based analysis. Surg Endosc 2024; 38:624-632. [PMID: 38012443 PMCID: PMC10830758 DOI: 10.1007/s00464-023-10572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The complication rate of modern antireflux surgery or paraesophageal hernia repair is unknown, and previous estimates have been extrapolated from institutional cohorts. METHODS A population-based retrospective cohort study of patient injury cases involving antireflux surgery and paraesophageal hernia repair from the Finnish National Patient Injury Centre (PIC) register between Jan 2010 and Dec 2020. Additionally, the baseline data of all the patients who underwent antireflux and paraesophageal hernia operations between Jan 2010 and Dec 2018 were collected from the Finnish national care register. RESULTS During the study period, 5734 operations were performed, and the mean age of the patients was 54.9 ± 14.7 years, with 59.3% (n = 3402) being women. Out of all operations, 341 (5.9%) were revision antireflux or paraesophageal hernia repair procedures. Antireflux surgery was the primary operation for 79.9% (n = 4384) of patients, and paraesophageal hernia repair was the primary operation for 20.1% (n = 1101) of patients. A total of 92.5% (5302) of all the operations were laparoscopic. From 2010 to 2020, 60 patient injury claims were identified, with half (50.0%) of the claims being related to paraesophageal hernia repair. One of the claims was made due to an injury that resulted in a patient's death (1.7%). The mean Comprehensive Complication Index scores were 35.9 (± 20.7) and 47.6 (± 20.8) (p = 0.033) for antireflux surgery and paraesophageal hernia repair, respectively. Eleven (18.3%) of the claims pertained to redo surgery. CONCLUSIONS The rate of antireflux surgery has diminished and the rate of paraesophageal hernia repair has risen in Finland during the era of minimally invasive surgery. Claims to the PIC remain rare, but claims regarding paraesophageal hernia repairs and redo surgery are overrepresented. Additionally, paraesophageal hernia repair is associated with more serious complications.
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Affiliation(s)
- Nelli M J Nurminen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Tommi K M Järvinen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Ville J Kytö
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Silja A S Salo
- Gastrointestinal Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Caitlin E Egan
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
| | | | - Jari V Räsänen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Ilkka K P Ilonen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
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Lee Y, Tahir U, Tessier L, Yang K, Hassan T, Dang J, Kroh M, Hong D. Long-term outcomes following Dor, Toupet, and Nissen fundoplication: a network meta-analysis of randomized controlled trials. Surg Endosc 2023:10.1007/s00464-023-10151-5. [PMID: 37308760 DOI: 10.1007/s00464-023-10151-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/20/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND In the surgical management of GERD, the traditional procedure is laparoscopic total (Nissen) fundoplication. However, partial fundoplication has been advocated as providing similar reflux control while potentially minimizing dysphagia. The comparative outcomes of different approaches to fundoplication are a topic of ongoing debate and long-term outcomes remain uncertain. This study aims to compare long-term gastroesophageal reflux disease (GERD) related outcomes following different fundoplication procedures. METHODS MEDLINE, EMBASE, PubMed, and CENTRAL databases were searched up to November 2022 to identify randomized controlled trials (RCTs) comparing different types of fundoplications reporting long-term (> 5 years) outcomes. The primary outcome was incidence of dysphagia. Secondary outcomes included incidence of heartburn/reflux, regurgitation, inability to belch, abdominal bloating, reoperation, and patient satisfaction. DataParty, which uses Python 3.8.10 was used to perform the network meta-analysis. We evaluated the overall certainty of evidence with the GRADE framework. RESULTS 13 RCTs were included, with 2063 patients across Nissen (360°), Dor (anterior 180°-200°), and Toupet (posterior 270°) fundoplications. Network estimates demonstrated that Toupet had lower incidence of dysphagia compared to Nissen (OR 0.285; 95% CrI 0.06-0.958). There were no differences in dysphagia between Toupet and Dor (OR 0.473, 95% CrI 0.072-2.835) or between Dor and Nissen (OR 1.689, 95% CrI 0.403-7.699). The three fundoplication types were comparable in all other outcomes. CONCLUSIONS All three approaches of fundoplication share similar long-term outcomes, with the Toupet fundoplication likely providing the best long-term durability with lowest odds of developing postoperative dysphagia.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Umair Tahir
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Lea Tessier
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Kevin Yang
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Taaha Hassan
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Jerry Dang
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Kroh
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.
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Park S, Park SH, Kim MS, Kwak J, Lee I, Kwon Y, Lee CM, Choi HS, Keum B, Yang KS, Park JM, Park S. Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication. Int J Surg 2023; 109:1239-1248. [PMID: 37026848 PMCID: PMC10389471 DOI: 10.1097/js9.0000000000000274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/26/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Currently, the reported parameters that predict the resolution of symptoms after surgery are largely subjective and unreliable. Considering that fundoplication rebuilds the structural integrity of the lower esophageal sphincter (LES), the authors focused on searching for objective and quantitative predictors for the resolution of symptoms based on the anatomical issues and whether an antireflux barrier can be well established or not. MATERIALS AND METHODS The authors reviewed the prospectively collected data of 266 patients with gastroesophageal reflux disease (GERD) who had undergone laparoscopic Nissen fundoplication (LNF). All patients were diagnosed with GERD using preoperative esophagogastroduodenoscopy, 24-h ambulatory esophageal pH monitoring, and high-resolution esophageal manometry. The patients received GERD symptom surveys using the validated Korean Antireflux Surgery Group questionnaire twice: preoperatively and 3 months after the surgery. RESULTS After excluding patients with insufficient follow-up data, 152 patients were included in the analysis. Multivariate logistic regression analyses revealed that a longer length of the LES and lower BMI determined better resolution of typical symptoms after LNF (all P <0.05). Regarding atypical symptoms, higher resting pressure of LES and DeMeester score greater than or equal to 14.7 were associated with better resolution after the surgery (all P <0.05). After LNF, typical symptoms improved in 34 out of 37 patients (91.9%) with a length of LES >greater than .05 cm, BMI less than 23.67 kg/m 2 , and atypical symptoms were resolved in 16 out of 19 patients (84.2%) with resting pressure of LES greater than or equal to 19.65 mm Hg, DeMeester score greater than or equal to 14.7. CONCLUSION These results show that the preoperative length and resting pressure of LES is important in the objective prediction of symptom improvement after LNF.
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Affiliation(s)
- Sangjun Park
- Department of Surgery, Korea University College of Medicine
| | - Shin-Hoo Park
- Department of Surgery, Korea University College of Medicine
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital
| | - Min Seo Kim
- Genomics and Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul
| | - Jisoo Kwak
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital
| | - Inhyeok Lee
- Department of Surgery, Korea University College of Medicine
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital
| | - Yeongkeun Kwon
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital
| | - Chang Min Lee
- Division of Foregut Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital
| | - Kyung-Sook Yang
- Department of Biostatistics, Korea University College of Medicine
| | - Joong-Min Park
- Department of Surgery, Chung-Ang University College of Medicine
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital
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Robotic revision surgery after failed Nissen anti-reflux surgery: a single center experience and a literature review. J Robot Surg 2023:10.1007/s11701-023-01546-6. [PMID: 36862348 PMCID: PMC9979125 DOI: 10.1007/s11701-023-01546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The gastroesophageal reflux disease (GERD) worldwide prevalence is increasing maybe due to population aging and the obesity epidemic. Nissen fundoplication is the most common surgical procedure for GERD with a failure rate of approximately 20% which might require a redo surgery. The aim of this study was to evaluate the short- and long-term outcomes of robotic redo procedures after anti-reflux surgery failure including a narrative review. METHODS We reviewed our 15-year experience from 2005 to 2020 including 317 procedures, 306 for primary, and 11 for revisional surgery. RESULTS Patients included in the redo series underwent primary Nissen fundoplication with a mean age of 57.6 years (range, 43-71). All procedures were minimally invasive and no conversion to open surgery was registered. The meshes were used in five (45.45%) patients. The mean operative time was 147 min (range, 110-225) and the mean hospital stay was 3.2 days (range, 2-7). At a mean follow-up of 78 months (range, 18-192), one patient suffered for persistent dysphagia and one for delayed gastric emptying. We had two (18.19%) Clavien-Dindo grade IIIa complications, consisting of postoperative pneumothoraxes treated with chest drainage. CONCLUSION Redo anti-reflux surgery is indicated in selected patients and the robotic approach is safe when it is performed in specialized centers, considering its surgical technical difficulty.
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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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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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Hung CM, Lee PH, Lu K, Chiu CC. Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials". ANNALS OF SURGERY OPEN 2022; 3:e173. [PMID: 37601144 PMCID: PMC10431498 DOI: 10.1097/as9.0000000000000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Chao-Ming Hung
- From the Department of General Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Huang Lee
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Kang Lu
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chong-Chi Chiu
- From the Department of General Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Medical Education and Research, E-Da Cancer Hospital, Kaohsiung, Taiwan
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11
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We Asked the Experts: "When is a Laparoscopic Fundoplication Warranted For Gastroesophageal Reflux Disease?". World J Surg 2022; 46:1711-1712. [PMID: 35391560 DOI: 10.1007/s00268-022-06541-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 10/18/2022]
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DIAGNOSIS AND CORRECTION OF COMPLICATIONS OF INSUFFICIENCY OF ANTI-REFLUX FUNCTION OF THE PHYSIOLOGICAL CARDIA IN HIATAL HERNIAS. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-4-82-20-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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