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Namata TT, Ndamenyi AN, Bukenya AH, Mukungu L, Bbosa B. Acute gastric volvulus complicated by gastric perforation following laparoscopic Nissen fundoplication; A case report. Int J Surg Case Rep 2024; 120:109904. [PMID: 38885606 PMCID: PMC11228632 DOI: 10.1016/j.ijscr.2024.109904] [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: 04/25/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Laparoscopic Nissen Fundoplication is an effective standard surgical procedure for treatment of severe GERD. While it is generally safe and effective, a rare but potentially fatal complication known as acute gastric volvulus can occur following this procedure. CASE PRESENTATION A 28-year-old male, ten months post Laparoscopic Nissen Fundoplication presented with a one-day history of severe epigastric pain, abdominal distention, unproductive retching, and difficulty in breathing. Examination revealed tachypnea, subcutaneous emphysema and a tender distended abdomen. Imaging studies showed a left pneumothorax, pneumoperitoneum, and a grossly distended stomach. Emergency exploratory laparotomy confirmed organoaxial gastric volvulus, necrosis of the greater curvature and gastric perforation. Partial gastrectomy and anterior gastropexy were performed. A left thoracostomy tube was placed to drain the left pneumothorax. He recovered fully post-operatively with complete resolution of all symptoms. DISCUSSION Acute Gastric volvulus post Laparoscopic Nissen Fundoplication is attributed to adhesions, gastrostomy tubes, and foreign bodies like sutures. Life-threatening complications, such as gastric perforation, can ensue, underscoring the need for swift diagnosis and treatment. CONCLUSION Acute gastric volvulus following Laparoscopic Nissen Fundoplication is a rare condition, and is difficult to diagnose. Given the steadily increasing rates of laparoscopic Nissen fundoplications performed in Uganda, maintaining a high index of suspicion is crucial for favorable patient outcomes among patients with this potentially fatal complication.
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Affiliation(s)
| | | | - Ali Henry Bukenya
- Department of Surgery, St. Francis Hospital Nsambya, Kampala, Uganda; Uganda Martyrs University, Kampala, Uganda
| | - Lukuman Mukungu
- Department of Surgery, St. Francis Hospital Nsambya, Kampala, Uganda; Uganda Martyrs University, Kampala, Uganda
| | - Brian Bbosa
- Department of Surgery, St. Francis Hospital Nsambya, Kampala, Uganda; Uganda Martyrs University, Kampala, Uganda; Consultant General Surgeon, St. Francis Hospital Nsambya, Kampala, Uganda
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Yao L, Lin Y, He X, Liu G, Wang B, Wang W, Li D. Efficacy of different endoscopic treatments for gastroesophageal reflux disease: a systematic review and network meta-analysis. J Gastrointest Surg 2024; 28:1051-1061. [PMID: 38670431 DOI: 10.1016/j.gassur.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND There are no direct comparisons across different endoscopic therapies for gastroesophageal reflux disease (GERD). This study aimed to evaluate the relative effects of different endoscopic therapies in GERD. METHODS Five databases were searched until August 2023 for randomized controlled trials (RCTs) that compared the efficacy of endoscopic band ligation (EBL), Stretta, endoscopic fundoplication (transoral incisionless fundoplication [TIF], endoscopic full-thickness plication [EFTP], and EndoCinch plication procedure [EndoCinch, CR BARD, Billerica, Mass., USA]), or proton pump inhibitors (PPIs)/sham procedure for GERD. Bayesian network meta-analysis was performed. RESULTS A total of 19 trials comprising 1181 patients were included. EBL (mean difference [MD], -7.75; 95% credible interval [CrI], -13.90 to -1.44), Stretta (MD, -9.86; 95% CrI, -19.05 to -0.58), and TIF (MD, -12.58; 95% CrI, -20.23 to -4.91) all significantly improved patients' health-related quality of life score with equivalent efficacy compared with PPIs. TIF and EBL achieved equivalent efficacy in reducing PPIs utility (risk ratio [RR], 0.66; 95% CrI, 0.40-1.05) and both were significantly superior to other endoscopic interventions (Stretta, EFTP, and EndoCinch). Besides, EBL and TIF also could significantly decrease the esophagitis incidence compared with PPIs (EBL [RR, 0.34; 95% CrI, 0.22-0.48] and TIF [RR, 0.38; 95% CrI, 0.15-0.88]). In terms of lower esophageal sphincter (LES) pressure, only TIF could significantly increase the LES pressure (MD, 6.53; 95% CrI, 3.65-9.40) to PPIs. In contrast, TIF was inferior to PPIs in decreasing esophageal acid exposure (MD, 2.57; 95% CrI, 0.77-4.36). CONCLUSION Combining the evidence, EBL and TIF may have comparable efficacy and both might be superior to Stretta, EFTP, or EndoCinch in GERD treatment.
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Affiliation(s)
- Lijia Yao
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Yanfang Lin
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Xiaojian He
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Gang Liu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Baoshan Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Wen Wang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Gastroenterology, 900TH Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China
| | - Dongliang Li
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, Fujian, China.
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Dowgiałło-Gornowicz N, Kacperczyk J, Masiewicz A, Osowiecka K, Lech P. Impact of Age on Long-Term Outcomes of Laparoscopic Nissen Fundoplication-A Single Center Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:688. [PMID: 38792871 PMCID: PMC11123177 DOI: 10.3390/medicina60050688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
Background and objectives: Gastroesophageal reflux disease (GERD) is a common disease affecting approximately 20% of the adult population. This study aimed to compare the results of laparoscopic Nissen fundoplication (LNF) in the treatment of GERD in patients of different age groups. Materials and Methods: A retrospective analysis was performed on patients who underwent LNF in one surgical department between 2014 and 2018. Patients were divided into three groups based on age: under 40 years of age, 40-65 years of age, and over 65 years of age. Results: A total of 111 patients (44.1% women) were analyzed in this study. The mean age was 50.2 ±15 years, and the mean follow-up was 50 months ± 16.6 months. Recurrence of symptoms occurred in 23%, 20%, and 23% in each age group, respectively (p = 0.13), and 85%, 89%, and 80% of patients from the respective groups reported that they would recommend the surgery to their relatives (p = 0.66). Furthermore, 83%, 92%, and 73% of patients from the respective age groups reported that they would undergo the surgery again with the knowledge they now had (p = 0.16). Conclusions: Given these results and observations, LNF has been shown to be a good method of treatment for GERD in every age group. In our study, there were no differences found in terms of satisfaction with surgery and associated recommendations between the studied age groups.
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Affiliation(s)
- Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległosci 44 St., 10-045 Olsztyn, Poland;
| | - Justyna Kacperczyk
- Department of Anesthesiology and Intensive Care, Children’s Memorial Health Institute, Av. Dzieci Polskich 20, 04-730 Warsaw, Poland;
| | - Anna Masiewicz
- Department of Neurology, Military Institute of Medicine, Szaserów 128 St., 04-141 Warszawa, Poland;
| | - Karolina Osowiecka
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, University of Warmia and Mazury in Olsztyn, Warszawska 30 St., 11-041 Olsztyn, Poland;
| | - Paweł Lech
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Niepodległosci 44 St., 10-045 Olsztyn, Poland;
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Killaars REM, Mollema O, Cakir H, Visschers RGJ, van Gemert WG. Robotic-Assisted Nissen Fundoplication in Pediatric Patients: A Matched Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:112. [PMID: 38255425 PMCID: PMC10814474 DOI: 10.3390/children11010112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Nissen Fundoplication (NF) is a frequently performed procedure in children. Robotic-assisted Nissen Fundoplication (RNF), with the utilization of the Senhance® Surgical System (SSS®) (Asensus Surgical® Inc., Durham, NC, USA) featuring 3 mm instruments, aims to improve precision and safety in pediatric surgery. This matched cohort study assesses the safety and feasibility of RNF in children using the SSS®, comparing it with Laparoscopic Nissen Fundoplication (LNF). METHODS AND RESULTS Twenty children underwent RNF with the SSS® between 2020 to 2023 and were 1:1 matched with twenty LNF cases retrospectively selected from 2014 to 2023. Both groups were similar regarding male/female ratio, age, and weight. Two of the twenty RNF cases (10%) experienced intraoperative complications, whereas three in the LNF group of whom two required reinterventions. The observed percentage of postoperative complications was 5% in the RNF group compared to 15% in the LNF group (p = 0.625). The operative times in the RNF group significantly dropped towards the second study period (p = 0.024). CONCLUSIONS Utilizing SSS® for NF procedures in children is safe and feasible. Observational results may tentatively suggest that growing experiences and continued development will lead to better outcomes based on more accurate and safe surgery for children.
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Affiliation(s)
- Rianne E. M. Killaars
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (H.C.); (R.G.J.V.)
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Omar Mollema
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Hamit Cakir
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (H.C.); (R.G.J.V.)
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ruben G. J. Visschers
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (H.C.); (R.G.J.V.)
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Wim G. van Gemert
- Department of Pediatric Surgery, MosaKids Children’s Hospital, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands; (H.C.); (R.G.J.V.)
- European Consortium of Pediatric Surgery (MUMC+, Uniklinik Aachen, Centre Hospitalier Chrétien Liège), Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
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Takahiro H, Uchiyama M, Tanami Y, Sato Y, Wakabayashi Y, Oguma E. A single-center experience of using milk scintigraphy in 251 pediatric patients: A retrospective study. Medicine (Baltimore) 2023; 102:e35746. [PMID: 37960826 PMCID: PMC10637527 DOI: 10.1097/md.0000000000035746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023] Open
Abstract
To report our experience with milk gastroesophageal scintigraphy and the management of gastroesophageal reflux (GER) in children. In 251 pediatric patients we recorded age, underlying disease, central nervous system (CNS) disorders, and GER management. GER management was classified based on treatment plans: grade 0, non-pharmacological treatment; grade 1, non-pharmacological but using a nasogastric tube; grade 2, pharmacological treatment; grade 3, transpyloric feeding; and grade 4, Nissen fundoplication surgery. Patients were included in classified groups with (grades 2, 3, and 4) and without (grades 0 and 1) GER treatment. We evaluated the GER height (classified based on the height of GER, grade 0; no GER, 1; GER in the lower esophagus, 2; GER in the upper esophagus), GER duration in the lower and upper esophagus, presence or absence of massive GER amounts in the lower and upper esophagus, and gastric emptying time. We compared milk scintigraphy results and patient characteristics between groups with (grades 2, 3, and 4) and without (grades 0 and 1) GER treatment. We treated 121 patients for GER. CNS disorders (presence/absence: 46/74 with vs 21/110 without treatment, P < .001). The GER height grade (1.7 ± 0.5 [range, 0-2] with vs 1.5 ± 0.7 [range, 0-2] without treatment, P = .002), massive GER amount (present/absent: 21/99 with vs 9/122 without treatment, P = .011), and duration of GER (seconds) (324.5 ± 508.3 [range, 0-1800] vs 125.0 ± 291.9 [range, 0-1750], P < .001) in the upper esophageal half differed significantly. Similarly massive GER amount (present/absent: 54/66 with vs 34/97 without treatment, P = .002) and GER duration (621.3 ± 601.0 [range, 0-1800] vs 349.8 ± 452.4 [range, 0-1800], P < .001) in the lower esophageal half differed significantly. Additionally, CNS disorders, age, and massive GER in the upper esophageal half differed significantly among grades 2 and 4 in treated patients (P < .05, P < .001, P < .05, respectively). Milk scintigraphy is useful for deciding whether GER treatment is indicated. However, the treatment plan needs to be decided based on each patient's condition.
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Affiliation(s)
- Hosokawa Takahiro
- Department of Radiology, Saitama Children’s Medical Center, Saitama, Japan
| | - Mayuki Uchiyama
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children’s Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children’s Medical Center, Saitama, Japan
| | - Yasuharu Wakabayashi
- Division of Radiological Technology, Saitama Children’s Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children’s Medical Center, Saitama, Japan
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Klimczak T, Strzelczyk J. Endoscopic anti-reflux mucosectomy (ARMS) and endoscopic anti-reflux ablation (ARMA) as a potential treatment for gastroesophageal reflux - preliminary report. POLISH JOURNAL OF SURGERY 2023; 96:1-5. [PMID: 38348994 DOI: 10.5604/01.3001.0053.9251] [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: 02/15/2024]
Abstract
<b><br>Introduction:</b> Gastroesophageal reflux (GERD) is one of the most common disorders of the alimentary tract. Apart from troublesome symptoms, untreated GERD can lead to Barrett's esophagus and, as a consequence, esophageal adenocarcinoma. As for now, the most common treatment of GERD is PPI pharmacotherapy. However, in a number of cases, this treatment is not sufficient or the patient does not tolerate PPI-group drugs. In such cases, interventional therapy is recommended. So far, laparoscopic fundoplication has been the only suggested option. Other, minimally invasive procedures such as Stretta, MUSE, TIFF, or EsophyX were not recommended due to the lack of clinical data. In 2014, Professor H.Inoue from the Digestive Diseases Center, Showa University in Japan reported on the first series of novel, endoscopic, anti-reflux procedures: anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA).</br> <b><br>Methods:</b> We conducted our prospective, single-center study in 30 patients (14 female, 16 male) with PPI-refractory GERD. All patients underwent FSSG and GERD-HRQL evaluation and GE junction pressure study prior, 6 weeks and 6 months after the procedures. After the procedure, all patients received PPI treatment for 4 weeks.</br> <b><br>Results:</b> We successfully completed the procedures in all 30 patients. The mean procedure time was 42 minutes. No complications occurred. In 86.67% (26) of our patients, we achieved total remission of GERD symptoms, FSSG scores < 6 and GERD-HRQL scores < 8.</br> <b><br>Conclusions:</b> The results of our study show that ARMS and ARMA are simple, safe, improve GERD-related symptoms, and restore the GE junction's anti-reflux capacity.</br>.
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Affiliation(s)
- Tomasz Klimczak
- Department of General, Transplant, Gastroenterological and Oncological Surgery, 1st Teaching Hospital, Medical University of Lodz, Clinic of General and Transplant Surgery, Medical University of Lodz, Poland
| | - Janusz Strzelczyk
- Department of General, Transplant, Gastroenterological and Oncological Surgery, 1st Teaching Hospital, Medical University of Lodz, Clinic of General and Transplant Surgery, Medical University of Lodz, Poland
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Hage K, Cornejo J, Allotey JK, Castillo-Larios R, Caposole MZ, Iskandar M, Kellogg TA, Galvani C, Elli EF, Ghanem OM. Feasibility and Outcomes of Simultaneous Gastric Bypass with Paraesophageal Hernia Repair in Elderly Patients. Obes Surg 2023; 33:2734-2741. [PMID: 37454304 DOI: 10.1007/s11695-023-06726-9] [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: 05/09/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Paraesophageal hernias (PEH) have a higher incidence in patients with obesity. Roux-en-Y gastric bypass (RYGB) with concomitant PEH repair is established as a valid surgical option for PEH management in patients with obesity. The safety and feasibility of this approach in the elderly population are not well elucidated. METHODS We performed a multicenter retrospective cohort study of patients aged 65 years and older who underwent simultaneous PEH repair and RYGB from 2008 to 2022. Patient demographics, hernia characteristics, postoperative complications, and weight loss data were collected. Obesity-related medical conditions' resolution rates were evaluated at the last follow-up. A matched paired t-test and Pearson's test were used to assess continuous and categorical parameters, respectively. RESULTS A total of 40 patients (82.5% female; age, 69.2 ± 3.6 years; BMI, 39.4 ± 4.7 kg/m2) with a mean follow-up of 32.3 months were included. The average hernia size was 5.8 cm. Most cases did not require mesh use during surgery (92.5%) with only 3 (7.5%) hernial recurrences. Postoperative complications (17.5%) and mortality rates (2.5%), as well as readmission (2.5%), reoperation (2.5%), and reintervention (0%) rates at 30-day follow-up were reported. There was a statistically significant resolution in gastroesophageal reflux disease (p < 0.001), hypertension (p = 0.019), and sleep apnea (p = 0.014). CONCLUSIONS The safety and effectiveness of simultaneous PEH repair and RYGB are adequate for the elderly population. Patient selection is crucial to reduce postoperative complications. Further studies with larger cohorts are needed to fully assess the impact of this surgery on elderly patients with obesity.
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Affiliation(s)
- Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jorge Cornejo
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Jonathan K Allotey
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Rocio Castillo-Larios
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Michael Z Caposole
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Mazen Iskandar
- Department of Surgery, Baylor Scott and White Medical Center, Waxahachie, TX, 75165, USA
| | - Todd A Kellogg
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carlos Galvani
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., LA, 70112, New Orleans, USA
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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Calabrese F, Poletti V, Auriemma F, Paduano D, Gentile C, Facciorusso A, Franchellucci G, De Marco A, Brandaleone L, Ofosu A, Samanta J, Ramai D, De Luca L, Al-Lehibi A, Zuliani W, Hassan C, Repici A, Mangiavillano B. New Perspectives in Endoscopic Treatment of Gastroesophageal Reflux Disease. Diagnostics (Basel) 2023; 13:2057. [PMID: 37370952 DOI: 10.3390/diagnostics13122057] [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: 03/30/2023] [Revised: 05/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Gastroesophageal reflux disease has a high incidence and prevalence in the general population. Clinical manifestations are heterogenous, and so is the response to medical treatment. Proton pump inhibitors are still the most common agents used to control reflux symptoms and for healing esophagitis, but they are not a one-size-fits-all solution for the disease. Patients with persistent troublesome symptoms despite medical therapy, those experiencing some adverse drug reaction, or those unwilling to take lifelong medications deserve valid alternatives. Anti-reflux Nissen fundoplication is an effective option, but the risk of adverse events has limited its spread. In recent years, advancements in therapeutic endoscopy have been made, and three major endoluminal alternatives are now available, including (1) the delivery of radiofrequency energy to the esophago-gastric junction, (2) transoral incisionless fundoplication (TIF), and (3) anti-reflux mucosal interventions (ARMI) based on mucosal resection (ARMS) and mucosal ablation (ARMA) techniques to remodel the cardia. Endoscopic techniques have shown interesting results, but their diffusion is still limited to expert endoscopists in tertiary centers. This review discusses the state of the art in the endoscopic approach to gastroesophageal reflux disease.
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Affiliation(s)
- Federica Calabrese
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Valeria Poletti
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Carmine Gentile
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy
| | | | - Alessandro De Marco
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Luca Brandaleone
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA
| | - Luca De Luca
- Endoscopic Unit, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Abed Al-Lehibi
- King Fahad Medical City, Faculty of Medicine, King Saud Bin Abduaziz University-Health Science, Riyadh 11525, Saudi Arabia
| | - Walter Zuliani
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
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Yost CC, Bhagat R, Blitzer D, Louis C, Han J, Wilder FG, Meguid RA. A primer for the student joining the general thoracic surgery service tomorrow: Primer 2 of 7. JTCVS OPEN 2023; 14:293-313. [PMID: 37425458 PMCID: PMC10328966 DOI: 10.1016/j.xjon.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/02/2023] [Accepted: 04/08/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Colin C. Yost
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Rohun Bhagat
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - David Blitzer
- Division of Cardiovascular Surgery, Columbia University, New York, NY
| | - Clauden Louis
- Division of Cardiothoracic Surgery, Brigham and Women’s Hospital, Boston, Mass
| | - Jason Han
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Fatima G. Wilder
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Robert A. Meguid
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
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Tasoudis P, Vitkos E, Haithcock BE, Long JM. Transthoracic fundoplication using the Belsey Mark IV technique versus Nissen fundoplication: A systematic review and meta-analysis. Surg Endosc 2023:10.1007/s00464-023-09931-w. [PMID: 36754871 DOI: 10.1007/s00464-023-09931-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/28/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Nissen fundoplication is considered the cornerstone surgical treatment for hiatal hernia repair. Belsey Mark IV (BMIV) transthoracic fundoplication is an alternative approach that is rarely utilized in today's minimally invasive era. This study aims to summarize the safety and efficacy of BMIV and to compare it with Nissen fundoplication. METHODS We searched MEDLINE, Scopus, and Cochrane Library databases for single arm and comparative studies published by March 31st, 2022, according to PRISMA statement. Inverse-variance weights were used to estimate the proportion of patients experiencing the studied outcome and random-effects meta-analyses were performed. RESULTS 17 studies were identified, incorporating 2136 and 638 patients that underwent Belsey Mark IV or Nissen fundoplication, respectively. A total of 13.8% (95% CI: 9.6-18.6) of the patients that underwent fundoplication with the BMIV technique had non-resolution of their symptoms and 3.5% (95% CI: 2.0-5.4) required a reoperation. Overall, 14.8% (95% CI: 9.5-20.1) of the BMIV arm patients experienced post-operative complications, 5.0% (95% CI: 2.0-9.0) experienced chronic postoperative pain and 6.9% (95% CI: 3.1-11.9) had a hernia recurrence. No statistically significant difference was observed between Belsey Mark IV and Nissen fundoplication in terms of post-interventional non-resolution of symptoms (odds ratio [OR]: 1.49 [95% Confidence Interval (95%CI):0.6-4.0]; p = 0.42), post-operative complications (OR:0.83, 95%CI: 0.5-1.5, p = 0.54) and in-hospital mortality (OR:0.69, 95%CI: 0.13-3.80, p = 0.67). Belsey Mark IV arm had significantly lower reoperation rates compared to Nissen arm (OR:0.28, 95%CI: 0.1-0.7, p = 0.01). CONCLUSIONS BMIV fundoplication is a safe and effective but technically challenging. The BMIV technique may offer benefits to patients compared to the laparoscopic Nissen fundoplication. These benefits, however, are challenged by the increased morbidity of a thoracotomy.
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Affiliation(s)
- Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Evangelos Vitkos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Benjamin E Haithcock
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Jason M Long
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Mohr C, Ciomperlik H, Dhanani N, Olavarria OA, Hannon C, Hope W, Roth S, Liang MK, Holihan JL. Evaluation of ICARUS Guidelines and Recommendations Not Supported by Randomized Controlled Trials. J Gastrointest Surg 2023; 27:390-397. [PMID: 36650419 DOI: 10.1007/s11605-023-05590-3] [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: 10/10/2022] [Accepted: 01/07/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND The ICARUS guidelines are a systematic review and Delphi process that provide recommendations in the treatment and management of patients with gastroesophageal reflux disease (GERD). Many of the recommendations were supported by randomized trials; some were not. This study assesses guidelines with limited evidence and weak endorsement. METHODS Four ICARUS guidelines were chosen: the role of fundoplication for patients with BMI > 35, regurgitation, chest pain, and extra-esophageal symptoms. A multicenter database of patients undergoing fundoplication surgery for GERD between 2015 and 2020 was used. Outcomes assessed were anatomic failure and symptom recurrence. Multivariable regression was performed. RESULTS Five institutions performed a fundoplication on 461 patients for GERD with a median of follow-up of 14.7 months (IQR 14.2). On multivariate analysis, patients with the chosen pre-operative comorbidities achieved comparable post-operative benefits. Patients with a BMI > 35 were not more likely to experience anatomic failure. Patients with pre-operative regurgitation had similar symptom recurrence rates to those without. Patients with non-cardiac chest pain had comparable rates of symptom recurrence to those without. Reporting a pre-operative chronic cough attributable to reflux was not associated with higher rates of post-operative symptom recurrence. DISCUSSION Among the ICARUS guidelines and recommendations, a small proportion was lacking evidence at low risk for bias and endorsement. The results of this multicenter study evaluated outcomes of patients with various pre-operative conditions: BMI > 35, chest pain attributable to reflux, extra-esophageal symptoms attributable to reflux, and regurgitation. Our findings endorse patients with these characteristics as candidates for anti-reflux surgery.
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Affiliation(s)
- Cassandra Mohr
- Department of Surgery, McGovern Medical School, Houston, TX, USA. .,Department of Surgery, Lyndon B. Johnson Hospital, 5656 Kelley St, Houston, TX, 77026, USA.
| | | | - Naila Dhanani
- Department of Surgery, McGovern Medical School, Houston, TX, USA
| | | | - Craig Hannon
- Department of Surgery, McGovern Medical School, Houston, TX, USA
| | - William Hope
- Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Scott Roth
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Mike K Liang
- Department of Surgery, HCA Healthcare Kingwood, University of Houston, Kingwood, Houston, TX, USA
| | - Julie L Holihan
- Department of Surgery, McGovern Medical School, Houston, TX, USA
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Lata T, Trautman J, Townend P, Wilson RB. Current management of gastro-oesophageal reflux disease-treatment costs, safety profile, and effectiveness: a narrative review. Gastroenterol Rep (Oxf) 2023; 11:goad008. [PMID: 37082451 PMCID: PMC10112961 DOI: 10.1093/gastro/goad008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 12/09/2022] [Accepted: 02/01/2023] [Indexed: 04/22/2023] Open
Abstract
Background The purpose of this study was to review the current management of gastro-oesophageal reflux disease (GORD), including treatment costs, safety profile and effectiveness. Methods A literature review was performed of randomized-controlled trials, systematic reviews, Cochrane reports and National/Societal guidelines of the medical, endoscopic and surgical management of GORD. Proton pump inhibitor (PPI) prescribing patterns and expenditure were reviewed in different countries, including Australia, Canada, New Zealand, UK and USA. Results Proton pump inhibitors (PPIs) are primarily indicated for control of GORD, Helicobacter pylori eradication (combined with antibiotics), preventing NSAID-induced gastrointestinal bleeding and treating peptic ulcer disease. There is widespread overprescribing of PPIs in Western and Eastern nations in terms of indication and duration, with substantial expense for national health providers. Despite a favourable short-term safety profile, there are observational associations of adverse effects with long-term PPIs. These include nutrient malabsorption, enteric infections and cardiovascular events. The prevalence of PPI use makes their long-term safety profile clinically relevant. Cost-benefit, symptom control and quality-of-life outcomes favour laparoscopic fundoplication rather than chronic PPI treatment. Laparoscopic fundoplication in long-term management of PPI-responsive GORD is supported by SAGES, NICE and ACG, and PPI-refractory GORD by AGA and SAGES guidelines. The importance of establishing a definitive diagnosis prior to invasive management is emphasized, especially in PPI-refractory heartburn. Conclusions We examined evidence-based guidelines for PPI prescribing and deprescribing in primary care and hospital settings and the need for PPI stewardship and education of health professionals. This narrative review presents the advantages and disadvantages of surgical, endoscopic and medical management of GORD, which may assist in shared decision making and treatment choice in individual patients.This paper was presented (GS020) at the 88th RACS Annual Scientific Conference, 6-10 May, 2019.
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Affiliation(s)
- Tahmina Lata
- Corresponding author. Faculty of Medicine and Health, University of Sydney, City Road, Camperdown, NSW 2006, Australia. Tel: +0061-2-93512222.
| | - Jodie Trautman
- General Surgery Department, Wollongong Hospital, Wollongong, NSW, Australia
| | - Philip Townend
- General Surgery Department, Gold Coast University Hospital, Southport, QLD, Australia
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Erin SA, Gololobov GY, Yurkyliev NA, Chicherina MA, Burmistrov AI, Gadlevskiy GS, Ovchinnikova UR, Gorbacheva IV, Gallyamov EA. THE DIAPHRAGM EVENTRATION UNDER THE GUISE OF RECURRENT PARAESOPHAGEAL HIATAL HERNIA. SURGICAL PRACTICE 2022. [DOI: 10.38181/2223-2427-2022-4-70-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The clinical case presented in this article illustrates one of the serious iatrogenic complications of Nissen fundoplication: diaphragmatic eventration. A 65-year-old patient was diagnosed with recurrent paraesophageal hiatal hernia. Intraoperatively, it was treated as diaphragmatic eventration. Laparoscopic Nissen refundoplication, suturing of the diaphragm defect was performed. The patient was discharged in satisfactory condition on the 5th day.
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Affiliation(s)
- S. A. Erin
- Medical Scientific and Educational Center of Moscow State University named after M.V. Lomonosov
| | - G. Yu. Gololobov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - M. A. Chicherina
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. I. Burmistrov
- National Medical Research Center of Surgery named after A.V. Vishnevsky
| | - G. S. Gadlevskiy
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - U. R. Ovchinnikova
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I. V. Gorbacheva
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. A. Gallyamov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University (Sechenov University)
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Crural closure, not fundoplication, results in a significant decrease in lower esophageal sphincter distensibility. Surg Endosc 2022; 36:3893-3901. [PMID: 34463870 DOI: 10.1007/s00464-021-08706-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/23/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The esophagogastric junction (EGJ) is a complex anti-reflux barrier whose integrity relies on both the intrinsic lower esophageal sphincter (LES) and extrinsic crural diaphragm. During hiatal hernia repair, it is unclear whether the crural closure or the fundoplication is more important to restore the anti-reflux barrier. The objective of this study is to analyze changes in LES minimum diameter (Dmin) and distensibility index (DI) using the endoluminal functional lumen imaging probe (FLIP) during hiatal hernia repair. METHODS Following implementation of a standardized operative FLIP protocol, all data were collected prospectively and entered into a quality database. This data were reviewed retrospectively for all patients undergoing hiatal hernia repair. FLIP measurements were collected prior to hernia dissection, after hernia reduction, after cruroplasty, and after fundoplication. Additionally, subjective assessment of the tightness of crural closure was rated by the primary surgeon on a scale of 1 to 5, 1 being the loosest and 5 being the tightest. RESULTS Between August 2018 and February 2020, 97 hiatal hernia repairs were performed by a single surgeon. FLIP measurements collected using a 40-mL volume fill without pneumoperitoneum demonstrated a significant decrease in LES Dmin (13.84 ± 2.59 to 10.27 ± 2.09) and DI (6.81 ± 3.03 to 2.85 ± 1.23 mm2/mmHg) after crural closure (both p < 0.0001). Following fundoplication, there was a small, but also statistically significant, increase in both Dmin and DI (both p < 0.0001). Additionally, subjective assessment of crural tightness after cruroplasty correlated well with DI (r = - 0.466, p < 0.001) and all patients with a crural tightness rating ≥ 4.5 (N = 13) had a DI < 2.0 mm2/mmHg. CONCLUSION Cruroplasty results in a significant decrease in LES distensibility and may be more important than fundoplication in restoring EGJ competency. Additionally, subjective estimation of crural tightness correlates well with objective FLIP evaluation, suggesting surgeon assessment of cruroplasty is reliable.
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Long-Term Outcomes of Chronic Cough Reduction after Laparoscopic Nissen Fundoplication—A Single-Center Study. Medicina (B Aires) 2021; 58:medicina58010047. [PMID: 35056354 PMCID: PMC8779940 DOI: 10.3390/medicina58010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases. It affects 20% of the adult population and is the third most common cause of chronic cough in adults. This study describes the results of LNF for the relief of GERD-related cough. Materials and Methods: The prospectively collected data on 135 laparoscopic LNF in our department from 2014 to 2018 were reviewed. During consultations, patients were asked about the frequency of symptoms using the GERD Impact Scale (GERD-IS), their satisfaction and recommendation to others, and their general condition after the procedure. Results: We analyzed 23 of 111 patients (20.7%) reporting chronic cough. The mean age was 47 years (range 27–76 years, ±13.9 years) and the mean follow-up time was 48.3 months (range 22.6–76.3 ± 18.05 months). Most patients reported relief from cough after the surgery (78.3%, p < 0.001). Five patients (22%) reported the recurrence of symptoms after a mean of 10.8 months (6–18 months). Seventeen patients (74%) would undergo the surgery again and 18 patients (78%) would recommend the surgery to their relatives. There was a statistically significant improvement in all symptoms from the GERD-IS (p < 0.05). Conclusions: LNF may play an important role in the management of GERD patients with extraesophageal symptoms. After LNF, most of the operated patients reported complete resolution of chronic cough and would recommend the procedure to their relatives.
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Patient Satisfaction after Laparoscopic Nissen Fundoplication-Long-Term Outcomes of Single-Center Study. J Clin Med 2021; 10:jcm10245924. [PMID: 34945219 PMCID: PMC8707538 DOI: 10.3390/jcm10245924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Up to 33% of the population suffers from gastroesophageal reflux disease (GERD). Given its high prevalence, the negative impact on quality of life, and the possible progression to esophageal cancer, the definitive treatment of GERD should be used more frequently. This study aims to assess long-term patient satisfaction after laparoscopic Nissen fundoplication (LNF). We reviewed the prospectively collected data of patients who underwent LNF for GERD in our department in 2014–2018. Each patient completed a preoperative questionnaire according to GERD Impact Scale (GERD-IS). Postoperative survey consisted of GERD-IS, the need for PPIs, and two “yes or no” questions to assess satisfaction with the outcome. The mean follow-up time was 50 months (21.2–76.3 ± 16.6 months). There was a statistically significant improvement in each GERD-IS question (p < 0.001). A total of 87 patients (78.4%) would recommend the surgery to their relatives. Patients without symptom recurrence and without the need for chronic PPI use after surgery were significantly more likely to recommend surgery and to undergo the procedure again (p < 001). The age of patients did not influence patients’ recommendations (p = 0.75). A total of 17 patients (15.3%) would not undergo LNF again. There was no significant correlation between the answer and patient’s complications or age (p > 0.05). LNF is a good treatment for GERD with a satisfaction rate of 78.4%.
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Laparoscopic Fundoplication Using the Excluded Stomach as a Novel Management Option for Refractory Bile Reflux Following One Anastomosis Gastric Bypass (OAGB). Obes Surg 2021; 32:561-566. [PMID: 34817792 PMCID: PMC8795036 DOI: 10.1007/s11695-021-05804-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/27/2022]
Abstract
Background One anastomosis gastric bypass (OAGB) is now a mainstream bariatric procedure. Refractory gastroesophageal reflux is a significant complication following OAGB, and conversion to Roux-en-Y has long been the treatment of choice for this issue. Strengthening the lower esophageal sphincter by Nissen fundoplication (NF) has been reported as an effective anti-reflux surgery. Here we report the short-term outcomes of a modified NF procedure using the excluded stomach (excluded stomach fundoplication—ESF) to treat refractory bile reflux in post-OAGB patients. Methods Thirteen post-OAGB patients underwent ESF for refractory bile reflux during the study, as detailed in the surgical technique. This paper reports the 12 patients whose follow-up data are available. Results Following ESF, the GERD-HRQL heartburn score improved from 22.7 ± 3.9 to 1.8 ± 3.5 (p < 0.05). The mean aggregate GERD-HRQL score improved from 27.9 ± 5.3 to 5.7 ± 5.9 (p < 0.05). The GERD-HRQL global satisfaction score showed that 100% of patients were satisfied with the improvement of symptoms. The mean VISICK score improved from 3.8 ± 0.39 to 1.2 ± 0.39 (p < 0.05). One patient was returned to the operating theatre to have the wrap loosened due to dysphagia. Eleven patients did not require PPIs after surgery. Conclusions ESF significantly improved the VISICK score and GERD-HRQL of post-OAGB patients with refractory bile reflux in the short term. The current study is being continued to increase the sample size and the follow-up period.
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Adverse events associated with transoral incisionless fundoplication (TIF) for chronic gastroesophageal reflux disease: a MAUDE database analysis. Surg Endosc 2021; 36:4956-4959. [PMID: 34750704 DOI: 10.1007/s00464-021-08851-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: 04/08/2021] [Accepted: 10/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transoral incisionless fundoplication (TIF) has been used for treating chronic gastroesophageal reflux disease (GERD) refractory to medical therapy. We aim to investigate the complications associated with TIF using a national database. METHODS We analyzed post-marketing surveillance data from the FDA Manufacturer and User Facility Device Experience (MAUDE) database from Jan 2011 through Jan 2021. RESULTS During the study period, approximately 95 event cases reported to the FDA. Approximately 131 patient complications were identified. The number of adverse events declined from 2011 to 2016 (R2 = 0.96) but increased from 2016 to 2020 (R2 = 0.99). The most common adverse event was perforation (19.8%), followed by laceration 17.6%, bleeding (9.2%), and pleural effusion (9.2%). The most common patient complications were treated using endoscopic clips (12.3%), chest tube or drain insertion (12.3%), use of endoscopic retriever device (11.1%), esophageal stent (8.6%), and emergent or open surgery (11.1%). CONCLUSIONS Adverse events from TIF range from mild to severe. Further research is needed to develop approaches aimed at reducing patient risks.
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Pulvirenti R, Tognon C, Bisoffi S, Ghidini F, De Corti F, Fascetti Leon F, Antoniello LM, Gamba P. Innovative Techniques Associated with Traditional Abdominal Surgery in Complex Pediatric Cases: A Tertiary Center Experience. CHILDREN-BASEL 2021; 8:children8100898. [PMID: 34682163 PMCID: PMC8534733 DOI: 10.3390/children8100898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
Pediatric abdominal surgery is constantly evolving, alongside the advent of new surgical technologies. A combined use of new tools and traditional surgical approaches can be useful in the management of complex cases, allowing less invasive procedures and sometimes even avoiding multiple interventions. This combination of techniques has implications even from the anesthetic point of view, especially in post-operative pain control. Thereby, tertiary level centres, including highly-specialized professionals and advanced equipment, can maximize the effectiveness of treatments to improve the final outcomes. Our paper aims to present some possible combinations of techniques recently used at our institution to provide a one-session, minimally invasive treatment within different areas of abdominal surgery.
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Affiliation(s)
- Rebecca Pulvirenti
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
- Correspondence: ; Tel.: +39-347-369-6172
| | - Costanza Tognon
- Anesthesiology Pediatric Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy;
| | - Silvia Bisoffi
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Filippo Ghidini
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Federica De Corti
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women’s and Children’s Health Department, University Hospital of Padua, 35128 Padua, Italy; (S.B.); (F.G.); (F.D.C.); (F.F.L.); (L.M.A.); (P.G.)
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Lechien JR, Mouawad F, Bobin F, Bartaire E, Crevier-Buchman L, Saussez S. Review of management of laryngopharyngeal reflux disease. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:257-267. [DOI: 10.1016/j.anorl.2020.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Yodice M, Mignucci A, Shah V, Ashley C, Tadros M. Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing. World J Gastroenterol 2021; 27:1751-1769. [PMID: 33967555 PMCID: PMC8072189 DOI: 10.3748/wjg.v27.i16.1751] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is one of the most commonly encountered digestive diseases in the world, with the prevalence continuing to increase. Many patients are successfully treated with lifestyle modifications and proton pump inhibitor therapy, but a subset of patients require more aggressive intervention for control of their symptoms. Surgical treatment with fundoplication is a viable option for patients with GERD, as it attempts to improve the integrity of the lower esophageal sphincter (LES). While surgery can be as effective as medical treatment, it can also be associated with side effects such as dysphagia, bloating, and abdominal pain. Therefore, a thorough pre-operative assessment is crucial to select appropriate surgical candidates. Newer technologies are becoming increasingly available to help clinicians identify patients with true LES dysfunction, such as pH-impedance studies and high-resolution manometry (HRM). Pre-operative evaluation should be aimed at confirming the diagnosis of GERD, ruling out any major motility disorders, and selecting appropriate surgical candidates. HRM and pH testing are key tests to consider for patients with GERD like symptoms, and the addition of provocative measures such as straight leg raises and multiple rapid swallows to HRM protocol can assess the presence of underlying hiatal hernias and to test a patient’s peristaltic reserve prior to surgery.
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Affiliation(s)
- Michael Yodice
- Department of Gastroenterology, Albany Medical College, Albany, NY 12208, United States
| | - Alexandra Mignucci
- Department of Gastroenterology, Albany Medical College, Albany, NY 12208, United States
| | - Virali Shah
- Department of Gastroenterology, Albany Medical College, Albany, NY 12208, United States
| | - Christopher Ashley
- Section of Gastroenterology, Stratton VA Medical Center, Albany, NY 12208, United States
| | - Micheal Tadros
- Department of Gastroenterology, Albany Medical Center, Schenectady, NY 12309, United States
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Affiliation(s)
- Fabio Cianchi
- Unit of Digestive Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy -
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Li S, Jiao S, Zhang S, Zhou J. Revisional Surgeries of Laparoscopic Sleeve Gastrectomy. Diabetes Metab Syndr Obes 2021; 14:575-588. [PMID: 33603423 PMCID: PMC7882429 DOI: 10.2147/dmso.s295162] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022] Open
Abstract
Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.
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Affiliation(s)
- Siyuan Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siqi Jiao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Siwei Zhang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
| | - Jiangjiao Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China
- Correspondence: Jiangjiao Zhou Department of General Surgery, The Second Xiangya Hospital, Central South University, No. 139 Middle Renmin Road, Changsha, Hunan, 410011, People’s Republic of China Email
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Schwameis K, Ayazi S, Zheng P, Grubic AD, Salvitti M, Hoppo T, Jobe BA. Efficacy of Magnetic Sphincter Augmentation Across the Spectrum of GERD Disease Severity. J Am Coll Surg 2020; 232:288-297. [PMID: 33387623 DOI: 10.1016/j.jamcollsurg.2020.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The performance and durability of various types of fundoplication are variable when stratified by disease severity. To date, magnetic sphincter augmentation (MSA) has not been evaluated in this context. We designed this study to determine the efficacy of MSA in the treatment of severe GERD. STUDY DESIGN Guided by previous studies, a DeMeester score (DMS) ≥ 50 was used as a cutoff point to define severe reflux disease. Subjects were divided into 2 groups using this cutoff, and outcomes of severe cases were compared with those with less severe disease (DMS < 50). RESULTS A total of 334 patients underwent MSA. Patients with severe disease had a higher mean preoperative DMS compared with those with mild to moderate GERD (79.2 [53.2] vs 22.8 [13.7], p < 0.0001). At a mean postoperative follow-up of 13.6 (10.4) months, there was no difference between the mean GERD Health-Related Quality of Life (HRQL) total scores in patients with severe disease compared with those with less severe GERD (8.8 [10] vs 9.2 [10.8], p = 0.9204). Postoperative mean DMS was not different between groups (17.3[23.0] vs 14.1[33.9], p = 0.71), and there was no difference in the prevalence of esophagitis (p = 0.52). Patients with severe disease were less likely to be free from use of proton pump inhibitors after surgery (85% vs 93.1%, p = 0.041). There were similar rates of postoperative dysphagia (10% vs 14%, p = 0.42) and need for device removal (3% vs 5%, p = 0.7463). CONCLUSIONS MSA is an effective treatment in patients with severe GERD and leads to significant clinical improvement across the spectrum of disease severity, with few objective outcomes being superior in patients with mild-to-moderate reflux disease.
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Affiliation(s)
| | - Shahin Ayazi
- Esophageal Institute, Allegheny Health Network, Pittsburgh, PA.
| | - Ping Zheng
- Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Andrew D Grubic
- Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | | | - Toshitaka Hoppo
- Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Blair A Jobe
- Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
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25
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Huettl F, Lang H, Paschold M, Bartsch F, Hiller S, Hensel B, Corvinus F, Grimminger PP, Kneist W, Huber T. Quality-based assessment of camera navigation skills for laparoscopic fundoplication. Dis Esophagus 2020; 33:5849144. [PMID: 32476009 DOI: 10.1093/dote/doaa042] [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: 01/09/2020] [Revised: 04/05/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022]
Abstract
Laparoscopic fundoplication is considered the gold standard surgical procedure for the treatment of symptomatic hiatus hernia. Studies on surgical performance in minimally invasive hiatus hernia repair have neglected the role of the camera assistant so far. The current study was designed to assess the applicability of the structured assessment of laparoscopic assistance skills (SALAS) score to laparoscopic fundoplication as an advanced and commonly performed laparoscopic upper GI procedure. Randomly selected laparoscopic fundoplications (n = 20) at a single institute were evaluated. Four trained reviewers independently assigned SALAS scoring based on synchronized video and voice recordings. The SALAS score (5-25 points) consists of five key aspects of laparoscopic camera navigation as previously described. Experience in camera assistance was defined as at least 100 assistances in complex laparoscopic procedures. Nine different surgical teams, consisting of five surgical residents, three fellows, and two attending physicians, were included. Experienced and inexperienced camera assistants were equally distributed (10/10). Construct validity was proven with a significant discrimination between experienced and inexperienced camera assistants for all reviewers (P < 0.05). The intraclass correlation coefficient of 0.897 demonstrates the score's low interrater variability. The total operation time decreases with increasing SALAS score, not reaching statistical significance. The applied SALAS score proves effective by discriminating between experienced and inexperienced camera assistants in an upper GI surgical procedure. This study demonstrates the applicability of the SALAS score to a more advanced laparoscopic procedure such as fundoplication enabling future investigations on the influence of camera navigation on surgical performance and operative outcome.
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Affiliation(s)
- Florentine Huettl
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Markus Paschold
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Fabian Bartsch
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Sebastian Hiller
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Benjamin Hensel
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Florian Corvinus
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Peter P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Werner Kneist
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany.,Department of General and Visceral Surgery, St. Georg Hospital, Eisenach, Germany
| | - Tobias Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
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26
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Caruso AM, Milazzo M, Tulone V, Acierno C, Girgenti V, Amoroso S, Bommarito D, Calcaterra V, Pelizzo G. High Resolution Manometry Guidance During Laparoscopic Fundoplication in Pediatric Surgically "Fragile" Patients: Preliminary Report. CHILDREN-BASEL 2020; 7:children7110215. [PMID: 33171722 PMCID: PMC7695016 DOI: 10.3390/children7110215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022]
Abstract
Background: High resolution manometry (HRM), has been recently introduced in clinical practice to detect esophageal intraluminal pressure and esophageal motor function. We evaluated the feasibility and usefulness of intraoperative esophageal HRM during antireflux laparoscopic procedures in pediatric cases with neurological impairment (NI) or esophageal atresia (EA). Methods: From January to November 2019, seven children (5 NI, 2 EA) with gastroesophageal reflux (GER) were enrolled. Data on intraoperative pressure changes of the esophagogastric junction (EGJ) and postoperative follow-up data were collected. Results: Average preoperative LES pressures were not significantly different from postoperative pressures. A sliding hernia was detected in all patients as evidenced by EGJ double peak pressures. Hernia correction after esophageal traction was complete in 71.4% of the patients, and residual hernia (<2 cm) was detected in 28.6%. Postoperative EGJ pressures were higher compared to preoperative sphincteric pressures (p < 0.001); in NI patients, higher postoperative values were noted compared to EA (p = 0.05). No sliding hernia and/or GER relapses were recorded. Two patients reported dysphagia postoperatively. Conclusions: Intraoperative HRM may optimize esophageal pressure changes during laparoscopic fundoplication. Further studies are needed to confirm the usefulness of a tailored surgical approach to reduce postoperative complications.
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Affiliation(s)
- Anna Maria Caruso
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (M.M.); (V.T.); (C.A.); (V.G.); (S.A.); (D.B.)
| | - Mario Milazzo
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (M.M.); (V.T.); (C.A.); (V.G.); (S.A.); (D.B.)
| | - Vincenzo Tulone
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (M.M.); (V.T.); (C.A.); (V.G.); (S.A.); (D.B.)
| | - Carlo Acierno
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (M.M.); (V.T.); (C.A.); (V.G.); (S.A.); (D.B.)
| | - Vincenza Girgenti
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (M.M.); (V.T.); (C.A.); (V.G.); (S.A.); (D.B.)
| | - Salvatore Amoroso
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (M.M.); (V.T.); (C.A.); (V.G.); (S.A.); (D.B.)
| | - Denisia Bommarito
- Pediatric Surgery Unit, Children’s Hospital, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy; (A.M.C.); (M.M.); (V.T.); (C.A.); (V.G.); (S.A.); (D.B.)
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Pediatric Unit, “V. Buzzi” Children’s Hospital, University of Milano, 20154 Milano, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, “V. Buzzi” Children’s Hospital, University of Milano, 20154 Milano, Italy
- Department of Biomedical and Clinical Science, “L. Sacco”, University of Milano, 20154 Milano, Italy
- Correspondence:
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27
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New treatment method for refractory gastroesophageal reflux disease (GERD): C-BLART (clip band ligation anti-reflux therapy)-a short-term study. Surg Endosc 2020; 34:4516-4524. [PMID: 31728750 DOI: 10.1007/s00464-019-07238-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES C-BLART (clip band ligation anti-reflux therapy) has been reported as a new alternative endoscopic treatment for refractory gastroesophageal reflux disease (GERD). This study evaluated the short-term efficacy of C-BLART for controlling GERD symptoms, esophageal acid exposure, esophagitis, and quality of life. METHODS Patients with refractory GERD were recruited for a nonrandomized concurrent comparison, with 60 patients in the C-BLART with tailored PPI use group and 43 patients in the BID proton pump inhibitor (PPI) group. The primary outcomes were esophageal acid exposure and the lower esophageal sphincter (LES) pressure. The GERD-Q score, esophagitis grade, and adherence degree were also recorded. Crossover from the BID PPI group to the C-BLART with tailored PPI use group was allowed after 6 months. RESULTS The LES pressure and GERD-Q score improved more in the C-BLART with tailored PPI use group (P < 0.001) after 6 months, with no significant difference in the decrease in esophagitis compared with the baseline endoscopic results (P = 0.268). Treatment with PPIs had been halted in 43% of the patients at 6 months after C-BLART. At 12 months after C-BLART, the DeMeester score showed a significant improvement compared with the baseline measurements (P = 0.025). The GERD-Q score and LES pressure did not significantly improve compared with the baseline values (P = 0.102, P = 0.184) in C-BLART with tailored PPI use group. At 6 to 12 months, n = 6 (10%) patients had undergone laparoscopic fundoplication to control their symptoms in all the patients after C-BLART. CONCLUSION C-BLART is a novel treatment for controlling refractory GERD symptoms, esophageal acid exposure, and LES pressure according to this short-term analysis, safely performed endoscopically to create an anti-reflux barrier with ligated bands. Despite improvements in DeMeester score, LES pressure, and GERD-Q scores in the C-BLART with tailored PPI use group, many patients continue to demonstrate objective evidence of GERD.
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28
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Savarino E, Frazzoni M, Marabotto E, Zentilin P, Iovino P, Costantini M, Tolone S, Battaglia E, Cicala M, Usai-Satta P, de Bortoli N, Penagini R, Savarino V. A SIGE-SINGEM-AIGO technical review on the clinical use of esophageal reflux monitoring. Dig Liver Dis 2020; 52:966-980. [PMID: 32513632 DOI: 10.1016/j.dld.2020.04.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
Patients with esophageal symptoms potentially associated with gastroesophageal reflux disease such as heartburn, regurgitation, chest pain, or cough represent one of the most frequent reasons for referral to gastroenterological evaluation. The utility of esophageal reflux monitoring in clinical practice is: (1) to accurately define reflux burden, (2) to segregate patients according to reflux monitoring results as true GERD, reflux hypersensitivity and functional heartburn, and (3) to establish a treatment plan. With this in mind, in the last decade, investigations and technical advances, with the introduction of impedance-pH monitoring and wireless pH capsule, have enhanced our understanding and management of GERD. The following recommendations were discussed and approved after a comprehensive review of the medical literature pertaining to reflux testing techniques and their recent application. This review created under the auspices of the Società Italiana di Gastroenterologia ed Endoscopia Digestiva (SIGE), Società Italiana di Neuro-Gastro-Enterologia e Motilità (SINGEM) and Associazione Italiana Gastroenterologi ed Endoscopisti Digestivi Ospedalieri (AIGO) is intended to help clinicians in applying reflux studies in the most fruitful manner within the context of their patients with esophageal symptoms.
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Affiliation(s)
- Edoardo Savarino
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Elisa Marabotto
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Patrizia Zentilin
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paola Iovino
- Gastroenterology Unit, University of Salerno, Salerno, Italy
| | - Mario Costantini
- Clinica Chirurgica III, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Edda Battaglia
- Gastroenterology and Endoscopy Unit, Cardinal Massaja Hospital, Asti, Italy
| | - Michele Cicala
- Unit of Digestive Diseases, Campus Bio Medico University, Rome, Italy
| | | | - Nicola de Bortoli
- Gastrointestinal Unit-Department of Translational Sciences and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit - Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Vincenzo Savarino
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
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29
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Banting SP, Badgery HE, Read M, Mashimo H. Rethinking gastroesophageal reflux disorder. Ann N Y Acad Sci 2020; 1482:177-192. [PMID: 32875572 DOI: 10.1111/nyas.14478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/28/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common clinical condition for which our understanding has evolved over the past decades. It is now considered a cluster of phenotypes with numerous anatomical and physiological abnormalities contributing to its pathophysiology. As such, it is important to first understand the underlying mechanism of the disease process for each patient before embarking on therapeutic interventions. The aim of our paper is to highlight the mechanisms contributing to GERD and review investigations and interpretation of these results. Finally, the paper reviews the available treatment modalities for this condition, ranging from medical intervention, endoscopic options through to surgery and its various techniques.
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Affiliation(s)
- Samuel P Banting
- Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Henry E Badgery
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, the University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Hiroshi Mashimo
- Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts
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30
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Boru CE, Manolescu N, Ulmeanu DI, Copca N, Constantinica V, Copaescu C, Silecchia G. Platelet-rich plasma PRP vs. absorbable mesh as cruroplasty reinforcement: a study on an animal model. MINIM INVASIV THER 2020; 31:252-261. [PMID: 32700986 DOI: 10.1080/13645706.2020.1795686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Reinforcement of posterior cruroplasty has been proposed to minimize the failure of hiatal hernia repair (HHR). The applications of autologous platelet-rich plasma (PRP) and absorbable mesh are barely reported in this area. AIMS To analyze local macroscopic and microscopic changes induced by mesh vs. PRP as reinforcement of HHR, using a reliable laparoscopic experimental porcine model. MATERIAL AND METHODS This prospective, comparative pilot study was conducted on 14 female pigs, aged four to six months. An iatrogenic hiatal defect was laparoscopically simulated and repaired, reinforced with Bio-A® mesh (group A) or PRP (group B). Specimen retrieval was performed after seven months for histopathological (HP) examination. RESULTS No local or general complications were registered, with complete resorption of reinforcements, that determined inflammatory infiltrates with local collagen production and tissue neo-vascularization. Group A had an increased mean chronic inflammation score (p = .3061), showing significant sclerotic collagenizing process. PRP enhanced angiogenesis, collagenizing, myofibroblast recruitment and tissue ingrowth. CONCLUSIONS No residual materials or evidence of anatomical distortion were found. Animal model was safe and reliable. This is the first report of complete absorption of Bio-A® positioned on crural area. HP results suggest the clinical application of PRP in HHR as a promising co-adjuvant to local remodeling and healing.Abbreviations: ASA: American Society of Anesthesiologists; AB: Alcian Blue; PAS: Periodic Acid-Schiff; CP: platelet concentrate; fPC: filtered plasma concentrate; GERD: gastro-esophageal reflux disease; HSA: hiatal surface area; HHR: hiatal hernia repair; HP: histopathological; HH: hiatal hernia; HE: hematoxylin and eosin; HR: hiatus repair alone; HRM: hiatus repair and acellular dermal matrix; NM: Nicolae Manolesccu; LNF: laparoscopic Nissen fundoplication; PC: posterior cruroplasty; PPP: platelet-poor plasma; RP: platelet-rich plasma.
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Affiliation(s)
- Cristian E Boru
- General Surgery and Bariatric Centre of Excellence IFSO-EC, AUSL LT-ICOT, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Latina, Italy.,General Surgery and Transplantation Department, 'Sf. Maria' Clinical Hospital, Bucharest, Romania
| | - Nicolae Manolescu
- Department of Clinical Anatomic Pathology, Faculty of Veterinary Medicine, 'Spiru Haret' University, Bucharest, Romania
| | - Dan I Ulmeanu
- General and Thoracic Surgery Department, 'Regina Maria Baneasa' Hospital, Bucharest, Romania
| | - Narcis Copca
- General Surgery and Transplantation Department, 'Sf. Maria' Clinical Hospital, Bucharest, Romania
| | - Victor Constantinica
- General Surgery and Transplantation Department, 'Sf. Maria' Clinical Hospital, Bucharest, Romania
| | - Catalin Copaescu
- General Surgery and Bariatric Centre of Excellence IFSO EAC-EC, Ponderas Academic Hospital, Bucharest, Romania
| | - Gianfranco Silecchia
- General Surgery and Bariatric Centre of Excellence IFSO-EC, AUSL LT-ICOT, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Latina, Italy
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31
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Lechien JR, Dapri G, Dequanter D, Rodriguez Ruiz A, Marechal MT, De Marrez LG, Saussez S, Fisichella PM. Surgical Treatment for Laryngopharyngeal Reflux Disease: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2020; 145:655-666. [PMID: 31046069 DOI: 10.1001/jamaoto.2019.0315] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Laryngopharyngeal reflux (LPR) is a prevalent disease that is usually treated with diet, lifestyle modifications, and proton pump inhibitor therapy. However, nearly 10% to 30% of patients do not achieve adequate acid suppression even with high doses of proton pump inhibitors. For these patients with resistant disease, fundoplication may be recommended but the success rate of fundoplication surgery on laryngopharyngeal symptoms and findings remains uncertain. Objective To determine whether fundoplication is associated with control of signs and symptoms in patients with LPR. Evidence Review A literature search was conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline to identify studies published between 1990 and 2018 about the efficacy of fundoplication on clinical outcomes of LPR. Three investigators screened publications for eligibility and exclusion based on predetermined criteria. Study design, patient characteristics, diagnostic method, exclusion criteria, treatment characteristics, follow-up, and quality of the outcome assessment were evaluated. Findings Of the 266 studies identified, 34 met the inclusion criteria, accounting for 2190 patients with LPR (1270 women and 920 men; mean [SD] age at the time of surgery, 49.3 [6.3] years). A weighted mean of 83.0% of patients (95% CI, 79.7%-86.3%) experienced improvement and a weighted mean of 67.0% of patients (95% CI, 64.1%-69.9%) experienced a disappearance of symptoms, but there is a high level of methodological heterogeneity among studies according to diagnostic method, exclusion criteria, and outcomes used to assess the efficacy of fundoplication. A pH study without impedance study was used in most studies but with various inclusion criteria. According to results of an a priori assessment, the clinical outcomes used were overall poor, excluding many symptoms and findings associated with LPR. Conclusion and Relevance The reported studies of fundoplication in LPR disease have important heterogeneity in method of diagnosis, exclusion criteria, symptoms, and signs assessed as therapeutic outcomes; therefore, this systematic review was nonconclusive regarding whether surgery for LPR disease is associated with effective control of sight and symptoms. Otolaryngologists, gastroenterologists, and surgeons must establish a diagnostic criterion standard, clear indications for surgery, and future clinical outcomes to precisely assess the effectiveness of treatment.
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Affiliation(s)
- Jérôme R Lechien
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium.,Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Giovanni Dapri
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Didier Dequanter
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Rodriguez Ruiz
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Thérèse Marechal
- Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lisa G De Marrez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France
| | - Sven Saussez
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, University of Mons Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Laryngopharyngeal Reflux Study Group of the Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, EpiCURA Hospital, Baudour, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU St-Pierre, CHU de Bruxelles, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Piero Marco Fisichella
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston Veterans Affairs Healthcare System, Boston, Massachusetts
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32
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Jeong E, Yoo IK, Yeniova AÖ, Yon DK, Cho JY. Confocal Laser Endomicroscopic Findings of Refractory Erosive Reflux Disease versus Non-Erosive Reflux Disease with Anti-Reflux Mucosectomy: An in vivo and ex vivo Study. Clin Endosc 2020; 54:55-63. [PMID: 32375457 PMCID: PMC7939765 DOI: 10.5946/ce.2020.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background/Aims To date, there is no standard tool to diagnose gastroesophageal reflux disease (GERD). Typically, GERD is a non-erosive reflux disease (NERD) that does not present endoscopic abnormalities. Confocal laser endomicroscopy (CLE) has been shown to be an effective tool to identify and diagnose GERD. We aimed to investigate the cellular and vascular changes in vivo and ex vivo through CLE in patients with GERD.
Methods Patients with refractory GERD who underwent mucosectomy were recruited. The distal esophagus was observed in vivo using CLE. Mucosectomy tissue was stained with acriflavine and CLE image was obtained ex vivo. We compared cellular and vascular changes in CLE between erosive reflux disease (ERD), NERD, and a control group.
Results Eleven patients who underwent anti-reflux mucosectomy and five control patients were enrolled in the study. Patients with ERD and NERD presented greater dilated intercellular space than patients in the control group on CLE image. The diameter, number, and cross-sectional area of the intra-papillary capillary loops (IPCLs) were significantly larger in the ERD group than in the NERD group. The irregular shape of the IPCLs were observed in both patients with ERD and NERD.
Conclusions The irregular shape of the IPCLs were significantly correlated with a positive diagnosis of GERD. CLE may diagnose NERD with high sensitivity and accuracy.
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Affiliation(s)
- Eunju Jeong
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - In Kyung Yoo
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Abdullah Özgür Yeniova
- Division of Gastroenterology, Department of Internal Medicine, Tokat Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
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Toprak SS, Gultekin Y. A combination of laparoscopic Nissen fundoplication and laparoscopic gastric plication for gastric esophageal reflux disease and morbid obesity. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2019. [DOI: 10.25083/2559.5555/4.2/81.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Yuce TK, Ellis RJ, Merkow RP, Soper NJ, Bilimoria KY, Odell DD. Post-operative complications and readmissions following outpatient elective Nissen fundoplication. Surg Endosc 2019; 34:2143-2148. [PMID: 31388808 DOI: 10.1007/s00464-019-07020-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/19/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Traditionally, laparoscopic Nissen fundoplication (LNF) has been considered an inpatient procedure. Advances in surgical and anesthetic techniques have led to a shift towards outpatient LNF procedures. However, differences in surgical outcomes between outpatient and inpatient LNF are poorly understood. The objectives of this study were (1) to describe the frequency of outpatient LNF in a national cohort and (2) to identify any differences in complications or readmission rates between outpatient and inpatient LNF. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify elective LNF cases from 2012 to 2016. Patients discharged on the day of surgery were compared to those discharged 24-48 h post-operatively. Outcomes included 30-day readmission and death or serious morbidity (DSM). Bivariate analyses were completed with Chi squared testing for categorical variables and two sided t tests for continuous variables. Associations between outpatient surgery and outcomes were assessed using multivariable logistic regression. Differences in readmission were analyzed using Kaplan-Meier failure estimates and log-rank tests. RESULTS Of 7734 patients who underwent elective LNF, 568 (7.3%) were discharged on the day of surgery. The overall 30-day readmission rate was 4.1% (n = 316) and the overall rate of DSM was 1.0% (n = 79). The most common 30-day readmission diagnoses overall were infectious complications (16.1%), dysphagia (12.9%), and abdominal pain (11.7%). On multivariable analysis, there was no association between outpatient surgery and 30-day readmission (3.9% vs. 4.1%; aOR 0.97, 95% CI 0.62-1.52, p = 0.908) or DSM (1.1% vs. 1.0%; aOR 0.91, 95%CI 0.36-2.29, p = 0.848). Kaplan-Meier analysis showed no difference in rates of hospital readmission between groups at 30-days from discharge (3.9% vs. 4.1%, p = 0.325). CONCLUSIONS Among patients undergoing elective LNF, there were no significant differences in post-operative complications and 30-day readmission when compared to traditional inpatient postoperative care. Further consideration should be given to transitioning LNF to an outpatient procedure.
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Affiliation(s)
- Tarik K Yuce
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan J Ellis
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nathaniel J Soper
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David D Odell
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor, Chicago, IL, 60611, USA. .,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Northwestern Institute for Comparative Effectiveness Research in Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Minimally invasive Roux-en-Y reconstruction as a salvage operation after failed nissen fundoplication. Surg Endosc 2019; 34:2211-2218. [DOI: 10.1007/s00464-019-07010-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/19/2019] [Indexed: 12/28/2022]
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Ayazi S, DeMeester SR, Hagen JA, Zehetner J, Bremner RM, Lipham JC, Crookes PF, DeMeester TR. Clinical Significance of Esophageal Outflow Resistance Imposed by a Nissen Fundoplication. J Am Coll Surg 2019; 229:210-216. [PMID: 30998974 DOI: 10.1016/j.jamcollsurg.2019.03.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/03/2019] [Accepted: 03/07/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Attention has been focused on the amplitude of esophageal body contraction to avoid persistent dysphagia after a Nissen fundoplication. The current recommended level is a contraction amplitude in the distal third of esophagus above the fifth percentile. We hypothesized that a more physiologic approach is to measure outflow resistance imposed by a fundoplication, which needs to be overcome by the esophageal contraction amplitude. STUDY DESIGN The esophageal outflow resistance, as reflected by the intra-bolus pressure (iBP) measured 5 cm above the lower esophageal sphincter (LES), was measured in 53 normal subjects and 37 reflux patients with normal esophageal contraction amplitude, before and after a standardized Nissen fundoplication. All were free of postoperative dysphagia. A test population of 100 patients who had a Nissen fundoplication was used to validate the threshold of outflow resistance to avoid persistent postoperative dysphagia. RESULTS The mean (SD) amplitude of the iBP in normal subjects was 6.8 (3.7) mmHg and in patients before fundoplication was 3.6 (7.0) mmHg (p = 0.003). After Nissen fundoplication, the mean (SD) amplitude of the iBP increased to 12.0 (3.2) mmHg (p < 0.0001 vs normal subjects or preoperative values). The 95th percentile value for iBP after a Nissen fundoplication was 20.0 mmHg and was exceeded by esophageal contraction in all patients in the validation population, and 97% of these patients were free of persistent postoperative dysphagia at a median 50-month follow-up. CONCLUSIONS Nissen fundoplication increases the outflow resistance of the esophagus and should be constructed to avoid an iBP > 20 mmHg. Patients whose distal third esophageal contraction amplitude is >20 mmHg have a minimal risk of dysphagia after a tension-free Nissen fundoplication.
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Affiliation(s)
- Shahin Ayazi
- Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, PA; Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Jeffrey A Hagen
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joerg Zehetner
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - John C Lipham
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Peter F Crookes
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Tom R DeMeester
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Viswanath YKS, Maguire N, Obuobi RB, Dhar A, Punnoose S. Endoscopic day case antireflux radiofrequency (Stretta) therapy improves quality of life and reduce proton pump inhibitor (PPI) dependency in patients with gastro-oesophageal reflux disease: a prospective study from a UK tertiary centre. Frontline Gastroenterol 2019; 10:113-119. [PMID: 31205650 PMCID: PMC6540282 DOI: 10.1136/flgastro-2018-101028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/31/2018] [Accepted: 08/19/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic antireflux radiofrequency treatment (Stretta) offers a therapeutic alternative for patients suffering from refractory gastro-oesophageal reflux disease (GORD). Current evidence suggests that the treatment may improve symptoms of GORD and decrease requirement for proton pump inhibitor (PPI) therapy. METHODS Prospective assessment of patients undergoing Stretta, between October 2014 and February 2016, in a UK tertiary referral centre was carried. All patients were assessed for suitability using endoscopy, contrast studies, and pH and manometry studies. The Gastro-oesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) was used to evaluate symptoms along with PPI dependency, pre-Stretta and post-Stretta treatment. Patients were followed up by outpatient clinic appointment and telephone consultation. RESULTS Fifty consecutive patients were followed up for a median of 771 days (range 499-1162) following treatment with Stretta. The average GERD-HRQL score improved from 46.2/75 (±14.2) preprocedure to 15.2/75 (±17.3) postprocedure. Dissatisfaction with GORD as measured in the GERD-HRQL decreased from 100% to 10% with three patients showing no improvement (non-responders) at follow up and two late failures at the time of this review. There were no complications and all cases were carried out as day cases. CONCLUSION There are currently few effective therapeutic alternatives to antireflux surgery for refractory GORD. This series corroborates the value and safety of Stretta as a viable option for selected patients who are unwilling or unable to undergo an operation. Stretta improves quality of life and decreases PPI dependency in selected patients with GORD.
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Affiliation(s)
- YKS Viswanath
- Upper GI Laparoscopic and endoscopic surgery, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - Nicola Maguire
- Upper GI Laparoscopic and endoscopic surgery, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - Reece-Bolton Obuobi
- Upper GI Laparoscopic and endoscopic surgery, James Cook University Hospital, Middlesbrough, Cleveland, UK
| | - Anjan Dhar
- Darlington Memorial Hospital, Bishop Auckland, UK
| | - Siby Punnoose
- Darlington Memorial Hospital, Bishop Auckland, UK,Gastroenterology, County Durham & Darlington NHS FoundationTrust
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Schoppmann SF, Kristo I, Riegler M. Does anti-reflux surgery disrupt the pathway of Barrett's esophagus progression to cancer? Transl Gastroenterol Hepatol 2019; 3:101. [PMID: 30701208 DOI: 10.21037/tgh.2018.11.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/28/2018] [Indexed: 11/06/2022] Open
Abstract
In patients with Barrett's esophagus (BE), anti-reflux surgery aims to sustainable control reflux symptoms and heal reflux induced esophageal mucosal inflammation and prevent progression of BE to adenocarcinoma. There is growing evidence that beside gastric acid, bile salts in refluxed duodenal juice are responsible for the development and progression of BE. However, the pathogenesis of BE progression and the metaplasia-dysplasia-carcinoma sequence of the adenocarcinoma of the esophagus (EAC) is multifactorial and occurs over long natural time course. After anti-reflux surgery significant levels of regression from metaplastic Barrett's to non-metaplastic epithelium as well as from dysplastic to non-dysplastic BE have been observed and a randomized trial showed that sufficient surgical reflux control reduces the risk of Barrett's progression significantly when compared to medical treatment. Thus, large cohort studies show significant reduced risk of EAC in patients suffering from gastroesophageal reflux disease (GERD) with and without BE after anti-reflux surgery. Even after anti-reflux surgery the risk for EAC remains elevated in patients with BE and the right moment of intercepting the progressive nature of GERD has to be discussed in future. The paper also addresses the impact of anti-reflux surgery, endoscopic ablation and life style therapies for the management of GERD, BE and cancer prevention.
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Affiliation(s)
- Sebastian F Schoppmann
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Centre (CCC), Vienna, Austria
| | - Ivan Kristo
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Centre (CCC), Vienna, Austria
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Common postoperative anatomy that requires special endoscopic consideration. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence. Esophagus 2018; 15:217-223. [PMID: 30225741 DOI: 10.1007/s10388-018-0616-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/17/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical results of GERD have mainly been reported from the Western countries, with a few reports found in Japan. We examined the surgical results of laparoscopic Toupet fundoplication and clarify the characteristics of recurrent cases. METHODS The subjects included 375 patients who underwent laparoscopic Toupet fundoplication from June 1997 to December 2016 as the initial surgery. Patient characteristics, pathophysiology, and surgical results were examined. In addition, we compared the patient characteristics and pathophysiology of recurrent cases in comparison with non-recurrent cases. RESULTS Age 59 (43-70) and male 211 (56.3%). The operation time was 141 min (113-180) and intraoperative complications were found to have onset in 13 subjects (3.5%). Dysphagia after surgery was found in 18 cases (4.8%). The A factor (the degree of hiatal hernia), P factor (the degree of esophagitis), and pH < 4 holding time significantly improved after surgery compared with prior to surgery (p < 0.001 for all), while the LES lengths and abdominal LES lengths were extended (p < 0.001 for each). Recurrence was found in 48 patients (15.1%) among the 318 patients for whom we could confirm the presence or absence of recurrence. The A factor, P factor, and pH < 4 holding time prior to surgery were, respectively, higher in the recurrence group (p = 0.031, p < 0.001, p < 0.001). CONCLUSIONS Laparoscopic Toupet fundoplication for GERD could be performed safely, with a response rate as good as 85%. Compared with non-recurrent cases, preoperative clinical conditions such as esophageal hiatal hernia, reflux esophagitis, and acid reflux time were all advanced in recurrent cases.
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Jehangir A, Parkman HP. Rome IV Diagnostic Questionnaire Complements Patient Assessment of Gastrointestinal Symptoms for Patients with Gastroparesis Symptoms. Dig Dis Sci 2018; 63:2231-2243. [PMID: 29808246 DOI: 10.1007/s10620-018-5125-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/16/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patient assessment of upper gastrointestinal symptoms (PAGI-SYM) questionnaire assesses severity of gastrointestinal symptoms in gastroparesis (Gp), dyspepsia, and gastroesophageal reflux disease. Rome IV Diagnostic Questionnaire (R4DQ), used to diagnose various functional gastrointestinal disorders, may also help to better understand symptoms of Gp. AIM To assess patients with Gp comparing PAGI-SYM to R4DQ. METHODS Patients with symptoms of Gp referred to our center from May 2016 to January 2018 filled out PAGI-SYM and R4DQ. RESULTS Out of 357 patients, 225 had delayed gastric emptying including 121 with idiopathic gastroparesis (IGp), 60 with diabetic gastroparesis (DGp), 25 with atypical Gp, and 19 with postsurgical gastroparesis (PSGp). Using PAGI-SYM, DGp had more severe retching and vomiting compared to IGp. PSGp had more severe upper abdominal pain compared to IGp. Using R4DQ, the average number of Rome IV diagnoses that Gp patients met criteria was 2.1 ± 0.1. Most Gp patients had functional dyspepsia (n = 197, 90.8%) and chronic nausea and vomiting syndrome (CNVS) (n = 181, 83.4%). Postprandial distress syndrome (PDS) was present in 189 patients (88.3%), and epigastric pain syndrome in 126 patients (59.8%). The combination of PDS and CNVS was seen in 76.5% of Gp patients. CONCLUSIONS In this study, Gp patients were characterized using the PAGI-SYM and R4DQ. DGp had more severe retching and vomiting, while PSGp had more severe upper abdominal pain. PDS and CNVS were the most prevalent Rome IV diagnoses. The combination of PDS and CNVS was typically seen in patients with Gp. R4DQ can be helpful to characterize Gp patients.
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Affiliation(s)
- Asad Jehangir
- Section of Gastroenterology, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA, 19140, USA
| | - Henry P Parkman
- Section of Gastroenterology, Department of Medicine, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA, 19140, USA.
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Hybrid appendectomy with classic trocar on McBurney's point. Wideochir Inne Tech Maloinwazyjne 2018; 13:57-61. [PMID: 29643959 PMCID: PMC5890840 DOI: 10.5114/wiitm.2017.70323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/02/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Appendectomy is still the most commonly performed intra-abdominal operation worldwide. Interestingly, it has not reached the same popularity as other laparoscopic surgical procedures. Although multiple techniques have been described, a standard approach has not been described for the laparoscopic technique yet. Aim To perform hybrid appendectomy for acute appendicitis on McBurney’s point, aiming to perform an easier and quicker procedure while limiting the trauma to the abdominal wall by obtaining the advantages of both laparoscopic and open techniques. Material and methods We retrospectively evaluated the results of 24 patients on whom we had performed hybrid appendectomy with an optical trocar on McBurney’s point for acute appendicitis in 1 year in terms of demographics, operative time, complications, hospital stay and cosmetic results. Results Twenty-one of the patients underwent hybrid appendectomy with a one-optic trocar on McBurney’s point. The mean operative time was 21.4 ±6.2 min. We did not encounter any postoperative complications in any of the patients. The median hospital stay was 1.2 ±1.0 days. The postoperative scar was minimal. Conclusions This technique is defined in the literature for the first time, and it is easy and feasible for the surgeons. It may reduce the operative time and costs when compared to the conventional laparoscopic technique, but prospective studies with more patients are needed for more certain results.
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A modified Nissen fundoplication: subjective and objective midterm results. Langenbecks Arch Surg 2018; 403:279-287. [PMID: 29549453 DOI: 10.1007/s00423-018-1660-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The failure rate of laparoscopic anti-reflux surgery is approximately 10-20%. The aim of our prospective study was to investigate whether a modified Nissen fundoplication (MNF) can improve reflux symptoms and prevent surgical treatment failure in the midterm. METHODS The MNF consisted of (1) suturing the esophagus to the diaphragmatic crura on each side using four non-absorbable stitches, (2) reinforcing clearly weak crura with a tailored Ultrapro mesh, and (3) fixing the upper stitch of the valve to the diaphragm. Forty-eight consecutive patients experiencing typical gastroesophageal reflux disease (GERD) symptoms at least three times per week for 6 months or longer were assessed before and after surgery using validated symptom and quality of life (GERD-HRQL) questionnaires, high-resolution manometry, 24-h impedance-pH monitoring, endoscopy, and barium swallow. RESULTS Mortality and perioperative complications were nil. At median follow-up of 46.7 months, the patients experienced significant improvements in symptom and GERD-HRQL scores. One patient presented with severe dyspepsia and another complained of dysphagia requiring a repeat surgery 12 months after the first operation. Esophageal acid exposure (8.8 vs 0.1; p < 0.0001), reflux number (62 vs 8.5; p < 0.0001), and symptom-reflux association (19 vs 0; p < 0.0001) significantly decreased postoperatively. The median esophagogastric junction contractile integral (EGJ-CI) from 31 cases (8.2 vs 21.2 mmHg cm; p = 0.0003) and the abdominal length of the lower esophageal sphincter (LES) (0 vs 16 mm; p = 0.01) increased postoperatively. CONCLUSIONS Our data demonstrate that the MNF is a safe and effective procedure both in the short term and midterm.
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System design and experimental research of lower esophageal sphincter stimulator for treatment of gastroesophageal reflux disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2177-2180. [PMID: 29060328 DOI: 10.1109/embc.2017.8037286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Electrical stimulation therapy (EST) of lower esophageal sphincters (LES) is a new technique for the treatment of gastroesophageal reflux disease (GERD). In this paper, an implantable LES stimulator with wireless power transmission is proposed for the treatment of GERD. The LES stimulator is composed of an implantable pulse generator (IPG), an external controller, and a wireless power transmission module. The IPG, whose area is 31×21 mm2, is designed to generate voltage-regulated constant-current stimulation pulses. The external controller allows for wireless programming of the IPG via a Bluetooth Low Energy (BLE) module. The wireless power transmission module provides power for the IPG. According to the measurement of output stimulus waveforms, the proposed LES stimulator is capable of delivering electrical stimulations with a current ranging between 0 and 8 mA. To evaluate the safety and efficacy of the proposed LES stimulator, experiments were performed on 12 male New Zealand white rabbits. Esophageal manometry was performed before and after the procedure and the LES pressure (LESP) has been recorded. The mean LESP is increased significantly in the stimulation group than the sham group (stimulation group: 9.25±1.24 mmHg vs 13.99 ±1.28 mmHg, p<;0.05; sham group: 9.00±1.22 mmHg vs 9.23±1.27 mmHg, p=0.267). The results show that the electrical stimulation delivered by the LES stimulator can safely and effectively increase resting LES pressure in acute animal models, suggesting that the implantable LES stimulator is a perspective approach for treating GERD in clinics.
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Sobrino-Cossío S, Soto-Pérez J, Coss-Adame E, Mateos-Pérez G, Teramoto Matsubara O, Tawil J, Vallejo-Soto M, Sáez-Ríos A, Vargas-Romero J, Zárate-Guzmán A, Galvis-García E, Morales-Arámbula M, Quiroz-Castro O, Carrasco-Rojas A, Remes-Troche J. Post-fundoplication symptoms and complications: Diagnostic approach and treatment. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Hu Z, Chen M, Wu J, Song Q, Yan C, Du X, Wang Z. Improved control of hypertension following laparoscopic fundoplication for gastroesophageal reflux disease. Front Med 2017; 11:68-73. [PMID: 28213877 DOI: 10.1007/s11684-016-0490-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/01/2016] [Indexed: 01/05/2023]
Abstract
This study aims to determine whether successful laparoscopic fundoplication for gastroesophageal reflux disease (GERD) can improve the control of hypertension. We conducted an observational study of GERD patients with hypertension. The esophageal and gastroesophageal symptoms of these patients were successfully treated with laparoscopic fundoplication, as measured by the reduced GERD symptoms and proton pump inhibitor consumption. A hypertension control scale was used to classify the use of antihypertensive medications and the quality of blood pressure control before and after anti-reflux surgery.Wilcoxon signed-ranks test was used for the statistical analyses. Seventy GERD patients were included in the analysis and followed up for a mean period of 3.5 ± 1.4 years. Prior to surgery, all participating patients were taking at least one class of antihypertensive medication, and 56 patients (80%) had intermittently high blood pressure. After surgery, the mean number of antihypertensive medication classes per patient was significantly reduced from 1.61 ± 0.77 pre-procedure to 1.27 ± 0.88 post-procedure (P < 0.001). The blood pressure of 48 of the 56 cases (86%) with preoperative intermittent high blood pressure returned to normal post procedure. A total of 50 patients (71%) recorded improvements on the hypertension control scale, with the overall mean score decreasing from 3.1 ± 1.0 preprocedure to 1.4 ± 1.0 post-procedure (P < 0.001). Therefore, successful laparoscopic fundoplication may result in better blood pressure control in some hypertensive GERD patients. This result suggests a possible connection between gastroesophageal reflux and hypertension.
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Affiliation(s)
- Zhiwei Hu
- Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing, 100088, China
| | - Meiping Chen
- Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing, 100088, China
| | - Jimin Wu
- Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing, 100088, China
| | - Qing Song
- Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing, 100088, China
| | - Chao Yan
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Xing Du
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Zhonggao Wang
- Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing, 100088, China. .,Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
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Triadafilopoulos G. Endoscopic Options for Gastroesophageal Reflux: Where Are We Now and What Does the Future Hold? Curr Gastroenterol Rep 2017; 18:47. [PMID: 27424219 DOI: 10.1007/s11894-016-0521-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Early in the twenty-first century, novel endoscopic techniques were introduced for the management of gastroesophageal reflux disease, providing minimally invasive ways to eliminate pharmacologic acid inhibition and avoid the need for anti-reflux surgery. These techniques do not significantly alter the anatomy of the gastroesophageal junction, minimizing short- and long-term adverse effects, such as dysphagia and bloating. After extensive clinical testing, many endoscopic therapies were abandoned due to either lack of durable efficacy or unfavorable safety profile. Today, only four such therapies remain clinically available, each with variable levels of clinical validation and market penetration. This review will provide an assessment of these endoscopic therapies, highlighting their respective strengths and weaknesses and their present and future applicability to patients with gastroesophageal reflux disease.
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Affiliation(s)
- George Triadafilopoulos
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, M-211, Stanford, CA, 94306, USA.
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Sobrino-Cossío S, Soto-Pérez JC, Coss-Adame E, Mateos-Pérez G, Teramoto Matsubara O, Tawil J, Vallejo-Soto M, Sáez-Ríos A, Vargas-Romero JA, Zárate-Guzmán AM, Galvis-García ES, Morales-Arámbula M, Quiroz-Castro O, Carrasco-Rojas A, Remes-Troche JM. Post-fundoplication symptoms and complications: Diagnostic approach and treatment. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:234-247. [PMID: 28065591 DOI: 10.1016/j.rgmx.2016.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/13/2016] [Accepted: 08/16/2016] [Indexed: 12/12/2022]
Abstract
Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.
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Affiliation(s)
- S Sobrino-Cossío
- Servicio de Endoscopia, Hospital Ángeles del Pedregal, Ciudad de México, México.
| | - J C Soto-Pérez
- Clínica de Fisiología Digestiva (Motilab), Clínica Medivalle, Ciudad de México, México; Clínica de Fisiología Digestiva, Hospital Ángeles Metropolitano, Ciudad de México, México; Servicio de Endoscopia, Hospital Central Sur de Alta Especialidad PEMEX, Ciudad de México, México
| | - E Coss-Adame
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto Nacional de Ciencias Médicas y de la Nutrición «Dr. Salvador Zubirán», Ciudad de México, México
| | - G Mateos-Pérez
- Servicio de Endoscopia, Hospital Ángeles del Pedregal, Ciudad de México, México
| | | | - J Tawil
- Departamento de Trastornos Funcionales Digestivos, Gedyt-Gastroenterología Diagnóstica y Terapéutica, Buenos Aires, Argentina
| | - M Vallejo-Soto
- Servicio de Cirugía General, Hospital Ángeles de Querétaro, Querétaro, México
| | - A Sáez-Ríos
- Servicio de Cirugía General, Hospital Central Militar, Ciudad de México, México
| | | | - A M Zárate-Guzmán
- Unidad de Endoscopia, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - E S Galvis-García
- Unidad de Gastroenterología, Hospital Privado, Guadalajara, Jalisco, México
| | - M Morales-Arámbula
- Unidad de Radiología, Hospital Ángeles del Pedregal, Ciudad de México, México
| | - O Quiroz-Castro
- Servicio de Cirugía General, Hospital Ángeles del Pedregal, Ciudad de México, México
| | - A Carrasco-Rojas
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, México
| | - J M Remes-Troche
- Laboratorio de Motilidad y Fisiología Digestiva, Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, México
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Bardini R, Rampado S, Salvador R, Zanatta L, Angriman I, Degasperi S, Ganss A, Savarino E. A modification of Nissen fundoplication improves patients' outcome and may reduce procedure-related failure rate. Int J Surg 2016; 38:83-89. [PMID: 28040500 DOI: 10.1016/j.ijsu.2016.12.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/24/2016] [Accepted: 12/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic anti-reflux surgery has a failure rate of 10-20%. We aimed to investigate whether a modification of Nissen fundoplication (MNF) may improve patients' outcome and reduce failure rate. MATERIALS & METHODS We prospectively compared 40 consecutive patients with gastroesophageal reflux disease who underwent anti-reflux surgery: 20 Nissen fundoplication (NF) and 20 the MNF approach. Eight cases in the MNF group needed redo surgery. The MNF consisted in suturing the esophagus to the diaphragmatic crura on each side by means of 4 non-absorbable stitches and in fixing the upper stitch of the valve to diaphragm. In case of clearly weak crura, a reinforcement with Ultrapro mesh was used. All patients were assessed before and after surgery using validated symptoms and quality of life (GERD-HRQL) questionnaires, manometry and 24-h impedance-pH monitoring, endoscopy and barium-swallow. RESULTS Mortality and postoperative complications were nil. At a median follow-up of 36 months, no significant differences emerged between the MNF and NF group in terms of symptoms, GERD-HRQL scores, manometric findings, and impedance-pH features. Dysphagia was not reported by the MNF group, while it was quite common (20% vs.0%, p = ns) in the NF group. Anti-reflux surgery was successful in all patients in the MNF group, whereas two patients in the NF group presented a slipped wrap and one recurrent reflux; two of these cases required redo-surgery (10% vs. 0%, p = ns). CONCLUSIONS Our preliminary data demonstrated that the MNF is a safe and effective procedure. Further, it seems to reduce the failure rate associated to the surgical procedure.
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Affiliation(s)
- Romeo Bardini
- General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy.
| | - Sabrina Rampado
- General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy.
| | - Renato Salvador
- General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy
| | - Lisa Zanatta
- General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy
| | - Imerio Angriman
- General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy
| | - Silvia Degasperi
- General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy
| | - Angelica Ganss
- General Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, School of Medicine, Padova, Italy
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Tolone S, Gualtieri G, Savarino E, Frazzoni M, de Bortoli N, Furnari M, Casalino G, Parisi S, Savarino V, Docimo L. Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors. World J Gastrointest Surg 2016; 8:719-728. [PMID: 27933133 PMCID: PMC5124700 DOI: 10.4240/wjgs.v8.i11.719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/17/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.
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