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Ichinose A, Konishi K, Takazawa S, Sunouchi T, Suzuki K, Yoshida M, Fujishiro J. Risk Factors for Recurrence of Gastroesophageal Reflux Disease After Laparoscopic Nissen Fundoplication in Patients With Severe Motor and Intellectual Disabilities. Asian J Endosc Surg 2025; 18:e70085. [PMID: 40425463 PMCID: PMC12116254 DOI: 10.1111/ases.70085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 04/21/2025] [Accepted: 05/04/2025] [Indexed: 05/29/2025]
Abstract
PURPOSE Laparoscopic Nissen fundoplication (LNF) is the standard surgical treatment for gastroesophageal reflux disease (GERD) in patients with severe motor and intellectual disabilities (SMID). It is necessary to prevent the recurrence of GERD because it poses multiple clinical and surgical challenges for these patients. In Japan, the Endoscopic Surgical Skill Qualification System (ESSQS) has been established to ensure technical competency in laparoscopic surgery for pediatric patients. Our aim was to elucidate the risk factors for recurrence of GERD after LNF in pediatric patients with SMID. METHODS Fifty patients with SMID who underwent LNF with gastrostomy for GERD at our institution between January 2009 and April 2022 were retrospectively investigated. Recurrence rate and risk factors were examined in univariate and multivariate analyses. RESULTS GERD recurred in 5 of the 50 patients (10.0%). In univariate analysis, operation time was significantly longer in the recurrence group than in the non-recurrence group (333 vs. 254 min, p = 0.01). No operations in the recurrence group were performed by an ESSQS-qualified surgeon (p = 0.28). In multivariate analysis, operation time was an independent risk factor for recurrence. CONCLUSION Operation time was identified as a risk factor for recurrence of GERD after LNF in patients with SMID. EVIDENCE II.
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Affiliation(s)
- Akinori Ichinose
- Department of Pediatric SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
| | - Ken‐ichiro Konishi
- Department of Pediatric SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
| | - Shinya Takazawa
- Department of Pediatric SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
| | - Tomohiro Sunouchi
- Department of Pediatric SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
| | - Keisuke Suzuki
- Department of Pediatric SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
| | - Mariko Yoshida
- Department of Pediatric SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
| | - Jun Fujishiro
- Department of Pediatric SurgeryGraduate School of Medicine, the University of TokyoTokyoJapan
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Watson AC, Watson DI. Antireflux surgeries and hiatal repair: keys to success. Expert Rev Gastroenterol Hepatol 2025; 19:181-195. [PMID: 39910806 DOI: 10.1080/17474124.2025.2464039] [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: 11/19/2024] [Revised: 01/20/2025] [Accepted: 02/04/2025] [Indexed: 02/07/2025]
Abstract
INTRODUCTION Gastroesophageal reflux is common, and when medical therapy is ineffective, alternative treatments should be considered. Nissen fundoplication controls reflux but can be followed by side effects such as dysphagia and flatulence. To improve outcomes, modifications have been advocated. AREAS COVERED Modifications to Nissen fundoplication and newer procedures for gastroesophageal reflux aim to improve overall outcome. Randomized controlled trials (RCTs) and long-term outcomes from large cohorts are prioritized to consider the optimal procedure for reflux and hiatus hernia. EXPERT OPINION Fundoplication is an effective treatment for gastroesophageal reflux, with success rates of >80% reported at 18-20-year follow-up. RCTs confirm that Nissen fundoplication delivers better reflux control than medication. However, some patients are troubled by side effects. Anterior and posterior partial fundoplication variants have been proposed as procedures that offer equally good reflux control, but fewer side effects, and RCTs have confirmed this with follow-up to 20 years. Which partial fundoplication is better is debated. Alternative laparoscopic or endoscopic approaches require expensive implants or equipment and deliver less reliable reflux control than partial fundoplication. Currently, level I evidence confirms that laparoscopic partial fundoplication delivers the optimal outcome in fit patients with reflux that is not well controlled by medication.
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Affiliation(s)
- Abigail Claire Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David Ian Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Yamamoto K, Inoue H, Tanaka I, Ushikubo K, Azuma D, Okada H, Nishikawa Y, Shimamura Y. Antireflux mucosectomy as an effective treatment for GERD after laparoscopic sleeve gastrectomy. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:389-392. [PMID: 39429909 PMCID: PMC11489506 DOI: 10.1016/j.vgie.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Affiliation(s)
- Kazuki Yamamoto
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ippei Tanaka
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Kei Ushikubo
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Daisuke Azuma
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Hiroki Okada
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yohei Nishikawa
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Loganathan P, Gajendran M, Perisetti A, Goyal H, Mann R, Wright R, Saligram S, Thosani N, Umapathy C. Endoscopic Advances in the Diagnosis and Management of Gastroesophageal Reflux Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1120. [PMID: 39064549 PMCID: PMC11278532 DOI: 10.3390/medicina60071120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/01/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024]
Abstract
Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett's esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages.
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Affiliation(s)
- Priyadarshini Loganathan
- Division of Gastroenterology & Nutrition, The University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA; (P.L.); (M.G.); (R.W.)
| | - Mahesh Gajendran
- Division of Gastroenterology & Nutrition, The University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA; (P.L.); (M.G.); (R.W.)
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 64128, USA;
| | - Hemant Goyal
- Department of Gastroenterology, Borland Groover, Baptist Medical Center-Downtown, Jacksonville, FL 32207, USA
| | - Rupinder Mann
- Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Randy Wright
- Division of Gastroenterology & Nutrition, The University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA; (P.L.); (M.G.); (R.W.)
| | - Shreyas Saligram
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, USA;
| | - Nirav Thosani
- Department of Surgery, McGovern Medical School at UT Health, Houston, TX 77030, USA;
| | - Chandraprakash Umapathy
- Division of Gastroenterology & Nutrition, Audie L. Murphy VA Hospital, San Antonio, TX 78229, USA;
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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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Sánchez-Pernaute A, Pérez-Aguirre E. Gastroesophageal reflux after Roux-en-Y gastric bypass: Is it just related to technical details? Cir Esp 2023; 101 Suppl 4:S58-S62. [PMID: 37952721 DOI: 10.1016/j.cireng.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/28/2023] [Indexed: 11/14/2023]
Abstract
Although it is uncommon, gastroesophageal reflux disease can present after Roux-en-Y gastric bypass, and it is usually related to technical errors. Hiatal hernia, a narrow calibrated gastrojejunostomy and a long gastric pouch are all factors associated with the development of pathologic gastroesophageal reflux. Techniques are available to treat this condition, such as fundoplications with the gastric remnant, gastropexy to the arcuate ligament, teres ligament repair, or sphincter augmentation with the LINX device. Despite the growing number of reports of gastroesophageal reflux after Roux-en-Y gastric bypass, it should be still considered the best surgical option for patients with obesity and a large hiatal hernia or complications secondary to gastroesophageal reflux disease.
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Eriksson SE, Maurer N, Zheng P, Sarici IS, DeWitt A, Riccardi M, Jobe BA, Ayazi S. Impact of Objective Colonic and Whole Gut Motility Data as Measured by Wireless Motility Capsule on Outcomes of Antireflux Surgery. J Am Coll Surg 2023; 236:305-315. [PMID: 36648258 PMCID: PMC9835684 DOI: 10.1097/xcs.0000000000000470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Studies show higher rates of dissatisfaction with antireflux surgery (ARS) outcomes in patients with chronic constipation. This suggests a relationship between colonic dysmotility and suboptimal surgical outcome. However, due to limitations in technology, there is no objective data available examining this relationship. The wireless motility capsule (WMC) is a novel technology consisting of an ingestible capsule equipped with pH, temperature, and pressure sensors, which provide information regarding regional and whole gut transit times, pH and motility. The aim of this study was to assess the impact of objective regional and whole gut motility data on the outcomes of ARS. STUDY DESIGN This was a retrospective review of patients who underwent WMC testing before ARS. Transit times, motility, and pH data obtained from different gastrointestinal tract regions were used in analysis to determine factors that impact surgical outcome. A favorable outcome was defined as complete resolution of the predominant reflux symptom and freedom from antisecretory medications. RESULTS The final study population consisted of 48 patients (fundoplication [n = 29] and magnetic sphincter augmentation [n = 19]). Of those patients, 87.5% were females and the mean age ± SD was 51.8 ± 14.5 years. At follow-up (mean ± SD, 16.8 ± 13.2 months), 87.5% of all patients achieved favorable outcomes. Patients with unfavorable outcomes had longer mean whole gut transit times (92.0 hours vs 55.7 hours; p = 0.024) and colonic transit times (78.6 hours vs 47.3 hours; p = 0.028), higher mean peak colonic pH (8.8 vs 8.15; p = 0.009), and higher mean antral motility indexes (310 vs 90.1; p = 0.050). CONCLUSIONS This is the first study to demonstrate that objective colonic dysmotility leads to suboptimal outcomes after ARS. WMC testing can assist with preoperative risk assessment and counseling for patients seeking ARS.
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Affiliation(s)
- Sven E Eriksson
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Nicole Maurer
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Ping Zheng
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Inanc S Sarici
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Ann DeWitt
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Margaret Riccardi
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
| | - Blair A Jobe
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
- the Department of Surgery, Drexel University, Philadelphia, PA (Jobe, Ayazi)
| | - Shahin Ayazi
- From the Esophageal Institute, Allegheny Health Network, Pittsburgh, PA
- the Department of Surgery, Drexel University, Philadelphia, PA (Jobe, Ayazi)
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Abdollahi A, Naghibi SM, Shariat Razavi H, Tavassoli A, Jabbari Nooghabi A, Jabbari Nooghabi M. Laparoscopic splenectomy in patients with idiopathic thrombocytopenic purpura and very low platelet count. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:368-374. [PMID: 35919640 PMCID: PMC9301219 DOI: 10.22088/cjim.13.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 03/10/2021] [Accepted: 04/10/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Chronic idiopathic thrombocytopenic purpura (ITP), is an autoimmune disease associated with a reduction in circulating blood platelets under 150±109g/L which persists longer than 6 months without any specific cause. With the current study, we aimed to evaluate the efficacy and safety of laparoscopic splenectomy in ITP patients with a very low platelet count and normal coagulation status. METHODS From April 2007 to January 2012, laparoscopic splenectomy was performed on 60 patients with chronic ITP who could not achieve a sustained recovery after steroid therapy. RESULTS Patients consisted of male/female ratio of 24 (40%):36 (60%) with the mean age of 53±15.1 years. All patients had normal coagulation state even with very low platelet count (below 5×103) before laparoscopic splenectomy. The mean operative time was 140.00±15.00 minutes. Blood transfusion was required in 10 (16.7%) and 8 (13.3%) patients before and after the operation, respectively. Preoperative transfusion of PRBC was not statistically significant between groups (P=0.265). Bleeding complications during within or after surgery was rare (5.0%). Convalescence was rapid and the mean hospital stay was 3.58±0.68 days (1-14 days) which shows that there was no significant difference in operative time and after operative hospitalization time among the three groups (P=0.070). The patients made a good uneventful recovery and were followed for at least one week who exhibited no postoperative problems. CONCLUSION Laparoscopic splenectomy should be considered initially in the management of ITP. Also, very low platelet count should not be contraindicated for laparoscopic splenectomy in ITP patients and sometimes perioperative platelet transfusion may be unnecessary.
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Affiliation(s)
- Abbas Abdollahi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence: Abbas Abdollahi, Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail: , Tel: 0098 5138022677, Fax: 0098 513852525
| | - Seyed Maryam Naghibi
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Shariat Razavi
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Tavassoli
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehdi Jabbari Nooghabi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran,Department of Statistics, Ferdowsi University of Mashhad, Mashhad, Iran
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Lefebvre JC, Belva P, Takieddine M, Vaneukem P. Laparoscopic Toupet Fundoplication : Prospective Study of 100 Cases. Results at One Year and Literature Review. Acta Chir Belg 2020. [DOI: 10.1080/00015458.1998.12098368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. C. Lefebvre
- Department of Digestive Surgery, C.H.U. de Charleroi, Charleroi, Belgium
| | - P. Belva
- Department of Digestive Surgery, C.H.U. de Charleroi, Charleroi, Belgium
| | - M. Takieddine
- Department of Digestive Surgery, C.H.U. de Charleroi, Charleroi, Belgium
| | - P. Vaneukem
- Department of Digestive Surgery, C.H.U. de Charleroi, Charleroi, Belgium
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Pelgrims N, Closset J, Sperduto N, Gelin M, Houben JJ. What did the Laparoscopic Nissen Approach of the Gastro-oesophageal Reflux Really Change for the Patients 8 Years Later? Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- N. Pelgrims
- Medicosurgical Department of Gastroenterology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - J. Closset
- Medicosurgical Department of Gastroenterology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - N. Sperduto
- Medicosurgical Department of Gastroenterology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - M. Gelin
- Medicosurgical Department of Gastroenterology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
| | - J. J. Houben
- Medicosurgical Department of Gastroenterology, Erasmus Hospital, Free University of Brussels, Brussels, Belgium
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Abstract
OBJECTIVE The aim of this study was to determine characteristics of the most cited publications in the history of the American Surgical Association (ASA). SUMMARY BACKGROUND DATA The Annals of Surgery has served as the journal of record for the ASA since 1928, with a special issue each year dedicated to papers presented before the ASA Annual Meeting. METHODS The top 100 most cited ASA publications in the Annals of Surgery were identified from the Scopus database and evaluated for key characteristics. RESULTS The 100 most cited papers from the ASA were published between 1955 and 2010 with an average of 609 citations (range: 333-2304) and are included among the 322 most cited papers in the Annals of Surgery. The most common subjects of study included clinical cancer (n = 43), gastrointestinal (n = 13), cardiothoracic/vascular (n = 9), and transplant (n = 9). Ninety-three institutions were included lead by Johns Hopkins University (n = 9), University of Pittsburgh (n = 8), Memorial Sloan-Kettering (n = 7), John Wayne Cancer Institute (n = 7), University of Texas (n = 7), and 5 each from Brigham and Women's Hospital, Mayo Clinic, and University of Chicago. The majority of manuscripts came from the United States (n = 85), followed by Canada (n = 7), Germany (n = 5), and Italy (n = 5). Study design included randomized controlled trials (n = 19), retrospective matched cohort studies (n = 11), retrospective nonmatched studies (n = 46), and other (n = 24). CONCLUSIONS The top 100 most cited publications from the ASA are highly impactful, landmark studies representing a diverse array of subject matter, investigators, study design, institutions, and countries. These influential publications have immensely advanced surgical science over the decades and should serve as inspiration for all surgeons and surgical investigators.
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Håkanson BS, Lundell L, Bylund A, Thorell A. Comparison of Laparoscopic 270° Posterior Partial Fundoplication vs Total Fundoplication for the Treatment of Gastroesophageal Reflux Disease: A Randomized Clinical Trial. JAMA Surg 2020; 154:479-486. [PMID: 30840057 DOI: 10.1001/jamasurg.2019.0047] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Importance Restoration of the esophagogastric junction competence is critical for effective long-term treatment of gastroesophageal reflux disease. Surgical repair results in such restoration, but mechanical adverse effects seem unavoidable. Minimizing these adverse effects without jeopardizing reflux control is warranted. Objective To determine whether partial fundoplication (PF) or total fundoplication (TF) is superior in laparoscopic antireflux surgery. Design, Setting, and Participants In this double-blind, randomized clinical trial of 1171 patients scheduled for laparoscopic antireflux surgery at a single university-affiliated center between November 19, 2001, and January 24, 2006, 456 patients were randomized and followed up for 5 years. Data were collected from November 2001 to April 2012, and data were analyzed from April 2012 to September 2018. Interventions A 270° posterior PF or a 360° Nissen TF. Main Outcomes and Measures Esophageal acid exposure at 3 years after surgery. Result Of the 456 randomized patients, 268 (58.8%) were male, and the mean (SD) age was 49.0 (11.7) years. A total of 229 patients were randomized to PF, and 227 patients were randomized to TF. At 3 years postoperatively, the median (interquartile range) esophageal acid exposure was reduced from 14.6% (9.8-21.9) to 1.8% (0.7-4.4) after PF and from 16.0% (10.4-22.7) to 2.5% (0.8-6.8) after TF (P = .31). Likewise, reflux symptoms were equally and effectively controlled. Early postoperative dysphagia (6 weeks) was common in both groups but then decreased toward normality. A small but statistically significant difference in favor of PF was noted in the mean (SD) scoring of dysphagia for liquids at 6 weeks (PF, 1.6 [0.9]; TF, 1.9 [1.3]; P = .01) and for solid food at 12 months (PF, 1.3 [1.0]; TF, 1.9 [1.4]; P < .001) and 24 months (PF, 1.3 [0.9]; TF, 1.7 [1.2]; P = .001). Quality of life was reduced before surgery but increased to normal values after surgery and remained so over 5-year follow-up, with no difference between the groups. Conclusions and Relevance The results from this randomized clinical trial suggest that although PF and TF could be recommended for treatment of gastroesophageal reflux disease, PF might be superior by inducing less dysphagia. Trial Registration ClinicalTrials.gov identifier: NCT03659487.
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Affiliation(s)
- Bengt S Håkanson
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Lars Lundell
- Department of Clinical Sciences, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Ami Bylund
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Ersta Hospital, Stockholm, Sweden
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Jonnalagadda S, Likhitsup A. Postsurgical Endoscopic Anatomy. CLINICAL GASTROINTESTINAL ENDOSCOPY 2019:124-140.e3. [DOI: 10.1016/b978-0-323-41509-5.00012-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Mayor MA, Fernando HC. Endoluminal Approaches to Gastroesophageal Reflux Disease. Thorac Surg Clin 2018; 28:527-532. [DOI: 10.1016/j.thorsurg.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Huang GS, Chance EA, Hileman BM, Emerick ES, Gianetti EA. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma. JSLS 2018; 21:JSLS.2017.00013. [PMID: 28584502 PMCID: PMC5444560 DOI: 10.4293/jsls.2017.00013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. Methods: Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. Results: Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. Conclusion: Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.
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Affiliation(s)
- Gregory S Huang
- Trauma and Critical Care Services, St Elizabeth Youngstown Hospital, Youngstown, Ohio, USA
| | - Elisha A Chance
- Trauma and Critical Care Services, St Elizabeth Youngstown Hospital, Youngstown, Ohio, USA
| | - Barbara M Hileman
- Trauma and Critical Care Services, St Elizabeth Youngstown Hospital, Youngstown, Ohio, USA
| | - Eric S Emerick
- Department of Sociology, Anthropology, and Gerontology, Youngstown State University, Youngstown, Ohio, USA
| | - Emily A Gianetti
- Department of Medical Education, Northeast Ohio Medical University, Rootstown, Ohio, USA
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Laparoscopic Surgery’s 100 Most Influential Manuscripts: A Bibliometric Analysis. Surg Laparosc Endosc Percutan Tech 2018; 28:13-19. [DOI: 10.1097/sle.0000000000000507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Schietroma M, Colozzi S, Pessia B, Carlei F, Di Furia M, Amicucci G. Laparoscopic Nissen fundoplication: The effects of high-concentration supplemental perioperative oxygen on the inflammatory and immune response: A randomised controlled trial. J Minim Access Surg 2018; 14:221-229. [PMID: 29582795 PMCID: PMC6001299 DOI: 10.4103/jmas.jmas_120_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background A number of studies have been reported on the effects of high-concentration oxygen (HCO) on cytokine synthesis, with controversial results. We assessed the effect of administration of perioperative HCO on systemic inflammatory and immune response in patients undergoing laparoscopic Nissen fundoplication (LNF). Materials and Methods Patients (n = 117) were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 58) or 80% (n = 59). Administration was commenced after induction of anaesthesia and maintained for 6 h after surgery. White blood cells, peripheral lymphocytes subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-1 and IL-6 and C-reactive protein (CRP) were investigated. Results A significantly higher concentration of neutrophil elastase, IL-1, IL-6 and CRP was detected post-operatively in the 30% FiO2group patients in comparison with the 80% FiO2group (P < 0.05). A statistically significant change in HLA-DR expression was recorded post-operatively at 24 h, as a reduction of this antigen expressed on monocyte surface in patients from 30% FiO2group; no changes were noted in 80% FiO2group (P < 0.05). Conclusions This study demonstrated that perioperative HCO (80%), during LNF, can lead to a reduction in post-operative inflammatory response, and possibly, avoid post-operative immunosuppression.
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Affiliation(s)
| | - Sara Colozzi
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | - Beatrice Pessia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
| | | | - Marino Di Furia
- Department of Surgery, University of L'Aquila, L'Aquila, Italy
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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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19
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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 GASTROENTEROLOGIA DE MEXICO 2017; 82:234-247. [PMID: 28065591 DOI: 10.1016/j.rgmx.2016.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Schwameis K, Zehetner J, Rona K, Crookes P, Bildzukewicz N, Oh DS, Ro G, Ross K, Sandhu K, Katkhouda N, Hagen JA, Lipham JC. Post-Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication. J Gastrointest Surg 2017; 21:441-445. [PMID: 27834011 DOI: 10.1007/s11605-016-3320-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Protracted dysphagia and bloating are potential troublesome side effects following Nissen fundoplication. The aim of this study was to evaluate the effects of conversion from Nissen to Toupet on dysphagia and bloating. METHODS The study used a retrospective chart review of all patients who had undergone conversion from Nissen to Toupet between 2001 and 2014. Endpoints were to determine the effect of conversion on dysphagia, bloating, and reflux control. RESULTS Twenty-five patients underwent conversion at a median of 3.7 years (1.4-10.5) after initial fundoplication. Indications were dysphagia in 19 (76%) and bloating syndrome in 6 (24%) patients. The median operative time was 104 min (86-146). There were no serious complications or mortality. Median follow-up was 27 months (0.8-130). Dysphagia was relieved in 16 (84%) and bloating in all 6 patients. Two patients developed reflux requiring a redo-Nissen. Two patients had persistent dysphagia and required endoscopic dilation. The GERD-HRQL post-conversion showed a median score of 5 (3-13). CONCLUSIONS Conversion relieved dysphagia in 84% and bloating in 100%. Significant recurrence of GERD was rare. Given the absence of serious complications, conversion should be considered in patients with severe bloating or dysphagia.
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Affiliation(s)
- Katrin Schwameis
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Jörg Zehetner
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Kais Rona
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Peter Crookes
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Nikolai Bildzukewicz
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Daniel S Oh
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Geoffrey Ro
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Katherine Ross
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Kulmeet Sandhu
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Namir Katkhouda
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - Jeffrey A Hagen
- Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA
| | - John C Lipham
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
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21
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Crawford C, Gibbens K, Lomelin D, Krause C, Simorov A, Oleynikov D. Sleeve gastrectomy and anti-reflux procedures. Surg Endosc 2016; 31:1012-1021. [PMID: 27440196 DOI: 10.1007/s00464-016-5092-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/05/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obesity is an epidemic in the USA that continues to grow, becoming a leading cause of premature avoidable death. Bariatric surgery has become an effective solution for obesity and its comorbidities, and one of the most commonly utilized procedures, the sleeve gastrectomy, can lead to an increase in gastroesophageal reflux following the operation. While these data are controversial, sometimes operative intervention can be necessary to provide durable relief for this problem. METHODS We performed an extensive literature review examining the different methods of anti-reflux procedures that are available both before and after a sleeve gastrectomy. RESULTS We reviewed several different types of anti-reflux procedures, including those that supplement the lower esophageal sphincter anatomy, such as magnetic sphincter augmentation and radiofrequency ablation procedures. Re-operation was also discussed as a possible treatment of reflux in sleeve gastrectomy, especially if the original sleeve becomes dilated or if a conversion to a Roux-en-Y gastric bypass or biliopancreatic diversion is deemed necessary. Sleeve gastrectomy with concomitant anti-reflux procedure was also reviewed, including the anti-reflux gastroplasty, hiatal hernia repair, and limited fundoplication. CONCLUSION A number of techniques can be used to mitigate the severity of reflux, either by maintaining the normal anatomic structures that limit reflux or by supplementing these structures with a plication or gastroplasty. Individuals with existing severe reflux should not be considered for a sleeve gastrectomy. New techniques that incorporate plication at the time of the index sleeve gastrectomy show some improvement, but these are in small series that will need to be further evaluated. The only proven method of treating intractable reflux after sleeve gastrectomy is conversion to a Roux-en-Y gastric bypass.
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Affiliation(s)
- Christopher Crawford
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Kyle Gibbens
- College of Medicine, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198-5520, USA
| | - Daniel Lomelin
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Crystal Krause
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Anton Simorov
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA
| | - Dmitry Oleynikov
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
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Antireflux Surgery and Risk of Esophageal Adenocarcinoma: A Systematic Review and Meta-analysis. Ann Surg 2016; 263:251-7. [PMID: 26501714 DOI: 10.1097/sla.0000000000001438] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the preventive effect of antireflux surgery against esophageal adenocarcinoma (EAC) compared with medical treatment of gastroesophageal reflux disease (GERD) and to the background population. BACKGROUND GERD is causally associated with EAC. Effective symptomatic treatment can be achieved with medication and antireflux surgery; however the possible preventive effect on EAC development remains unclear. METHODS This systematic review identified 10 studies comparing EAC risk after antireflux surgery with nonoperated GERD patients, including 7 studies of patients with Barrett's esophagus, and 2 studies comparing EAC risk after antireflux surgery to the background population. A fixed-effects Poisson meta-analysis was conducted to calculate pooled incidence rate ratios (IRR) and 95% confidence intervals (CIs). RESULTS The pooled IRR in patients after antireflux surgery was 0.76 (95% CI 0.42-1.39) compared with medically treated GERD patients. In patients with Barrett's esophagus, the corresponding IRR was 0.46 (95% CI 0.20-1.08), and 0.26 (95% CI 0.09-0.79) when restricted to publications after 2000. There was no difference in EAC risk between antireflux surgery and medical treatment in GERD patients without known Barrett's esophagus (IRR 0.98, 95% CI 0.72-1.33). The EAC risk remained elevated in patients after antireflux surgery compared with the background population (IRR 10.78, 95% CI 8.48-13.71). Although the clinical heterogeneity of the included studies was high, the statistical heterogeneity was low. CONCLUSIONS Antireflux surgery may prevent EAC better than medical therapy in patients with Barrett's esophagus. The EAC risk after antireflux surgery does not seem to revert to that of the background population.
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Petryszyn P, Staniak A, Grzegrzolka J. Is the use of esomeprazole in gastroesophageal reflux disease a cost-effective option in Poland? J Comp Eff Res 2016; 5:169-78. [PMID: 26946951 DOI: 10.2217/cer.15.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To compare the cost-effectiveness of therapy of gastroesophageal reflux disease with esomeprazole and other proton pump inhibitors (PPIs) in Poland. MATERIALS & METHODS Studies comparing esomeprazole with other PPIs in the treatment of erosive esophagitis, non-erosive reflux disease and gastroesophageal reflux disease maintenance therapy were systematically reviewed. 9 randomized clinical trials were selected, meta-analyses were conducted. Cost data derived from Polish Ministry of Health and Pharmacies in Wroclaw. RESULTS In the treatment of erosive esophagitis esomeprazole was significantly more effective than other PPIs. Both for 4- and 8-week therapy respective incremental cost-effectiveness ratio values were acceptably low. Differences in effectiveness of non-erosive reflux disease therapy were not significant. The replacement of pantoprazole 20 mg with more effective esomeprazole 20 mg in the 6-month maintenance therapy was associated with a substantially high incremental cost-effectiveness ratio.
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Affiliation(s)
- Pawel Petryszyn
- Department of Clinical Pharmacology, Wroclaw Medical University, Poland
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Endoscopic clipping of the Z-line (CMZL) helps recognize anatomical failures after Nissen fundoplication: technical report of a new method. Wideochir Inne Tech Maloinwazyjne 2015; 10:363-7. [PMID: 26649081 PMCID: PMC4653273 DOI: 10.5114/wiitm.2015.54315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Nearly 15% of patients after laparoscopic antireflux surgery experience recurrence of symptoms or develop new gastrointestinal symptoms. Some of them require redo procedures. It can be demanding to reveal anatomical failure after previous fundoplication. Aim To present a method which assists in recognition of anatomical failures after Nissen fundoplication. Material and methods Five patients with previous laparoscopic Nissen fundoplication and severe gastrointestinal symptoms were included in this study. During the esophagogastroduodenoscopy (EGDS) two radiopaque metal clips were placed to mark the Z-line (“clips-marked Z-line” – CMZL). It was done to achieve precise visualization of the gastroesophageal junction area in the video contrast investigation. Distinctions between conclusions after the EGDS, ordinary video contrast investigation, video contrast investigation with CMZL and intraoperative findings were analyzed. Results All patients underwent laparoscopic refundoplication with good postoperative results. There were 4 cases misdiagnosed by contrast investigation without clips and four cases misdiagnosed by EGDS. Endoscopic clipping helped to recognize correctly all anatomical failures. Conclusions Applying CMZL as a routine investigation before redo fundoplication can reduce frequency of misdiagnosis and help to perform redo fundoplication in appropriate patients, but it requires further studies on larger cohorts of patients.
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25
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Simic´ A, Skrobić O, Veličković D, Ražnatović Z, Šaranović Đ, Šljukić V, Jovanović S, Ivanović N, Peško P. Minimally invasive surgery for benign esophageal disorders: first 200 cases. Eur Surg 2015. [DOI: 10.1007/s10353-015-0296-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Toomey P, Teta A, Patel K, Ross S, Sukharamwala P, Rosemurgy AS. Transoral Incisionless Fundoplication: Is it as Safe and Efficacious as a Nissen or Toupet Fundoplication? Am Surg 2014. [DOI: 10.1177/000313481408000918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Transoral incisionless fundoplication (TIF) was U.S. Food and Drug Administration-approved in 2007 to treat gastroesophageal reflux disease (GERD), but comparative data are lacking. This study was undertaken to compare outcomes for patients with GERD undergoing TIF versus laparoscopic Nissen or Toupet fundoplications. We undertook a case-controlled study of three cohorts of 20 patients undergoing TIF or laparoscopic Nissen or Toupet fundoplications from 2010 to 2013 controlling for age, body mass index, and preoperative DeMeester scores. All patients were pro-spectively followed. Median data are reported. Patients undergoing TIF had significantly shorter operative times (in minutes: 71 vs 119 and 85, respectively, P < 0.001) and length of stay (in days: 1, 2, and 1, respectively, P < 0.001). No matter the approach, patients reported dramatic and similar reduction in symptom frequency and severity (e.g., heartburn 8 to 0, P < 0.05). At follow-up, 83 per cent of patients after TIF, 80 per cent after Nissen, or 92 per cent after Toupet fundoplications had symptoms less than once per month ( P = 0.12). TIF leads to dramatic symptom resolution, similar when compared with Nissen or Toupet fundoplications. TIF promotes shorter operative times and lengths of stay. Patient satisfaction and effective palliation of symptoms show that TIF is safe and efficacious in comparison to Nissen and Toupet fundoplications and support its continued application and evaluation.
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27
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Tolone S, Docimo G, Del Genio G, Brusciano L, Verde I, Gili S, Vitiello C, D'Alessandro A, Casalino G, Lucido F, Leone N, Pirozzi R, Ruggiero R, Docimo L. Long term quality of life after laparoscopic antireflux surgery for the elderly. BMC Surg 2014. [PMID: 24267446 DOI: 10.1186/1471-2482-13-s2-s10\r1471-2482-13-s2-s10[pii]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. METHODS Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. RESULTS Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). CONCLUSIONS In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.
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Ross SB, Choung E, Teta AF, Colibao L, Luberice K, Paul H, Rosemurgy AS. The learning curve of laparoendoscopic single-Site (LESS) fundoplication: definable, short, and safe. JSLS 2014; 17:376-84. [PMID: 24018072 PMCID: PMC3771754 DOI: 10.4293/108680813x13654754535359] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The learning curve for laparoendoscopic single-site (LESS) surgery was found to be definable, short, and safe. Background and Objectives: This study of laparoendoscopic single-site (LESS) fundoplication for gastroesophageal reflux disease was undertaken to determine the “learning curve” for implementing LESS fundoplication. Methods: One hundred patients, 38% men, with a median age of 61 years and median body mass index of 26 kg/m2, underwent LESS fundoplications. The operative times, placement of additional trocars, conversions to “open” operations, and complications were compared among patient quartiles to establish a learning curve. Median data are reported. Results: The median operative times and complications did not differ among 25-patient cohorts. Additional trocars were placed in 27% of patients, 67% of whom were in the first 25-patient cohort. Patients undergoing LESS fundoplication had a dramatic relief in the frequency and severity of all symptoms of reflux across all cohorts equally (P < .05), particularly for heartburn and regurgitation, without causing dysphagia. Conclusion: LESS fundoplication ameliorates symptoms of gastroesophageal reflux disease without apparent scarring. Notably, few operations required additional trocars after the first 25-patient cohort. Patient selection became more inclusive (eg, more “redo” fundoplications) with increasing experience, whereas operative times and complications remained relatively unchanged. The learning curve of LESS fundoplication is definable, short, and safe. We believe that patients will seek LESS fundoplication because of the efficacy and superior cosmetic outcomes; surgeons will need to meet this demand.
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Affiliation(s)
- Sharona B Ross
- Florida Hospital Tampa, 3000 Medical Park Dr, Ste 310, Tampa, FL 33613, USA.
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Owen B, Simorov A, Siref A, Shostrom V, Oleynikov D. How does robotic anti-reflux surgery compare with traditional open and laparoscopic techniques: a cost and outcomes analysis. Surg Endosc 2014; 28:1686-90. [PMID: 24414455 DOI: 10.1007/s00464-013-3372-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 12/05/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Conventional laparoscopic fundoplications (CLF) have been the gold standard for Nissen fundoplications (NFs) for two decades. The advent of a robotic approach for fundoplication procedures creates a potential alternative. Thus, we used a national database to examine perioperative outcomes with respect to open, laparoscopic, and robotic approaches. METHODS The University Health System Consortium is an alliance of medical centers, numbering over 115 academic institutions and their 271 affiliated hospitals. We used International Classification of Diseases codes to elicit patients over the age of 18 years who received NF procedures. RESULTS A total of 12,079 patients of similar demographic background received fundoplication procedures from October 2008 to June 2012. Of those, 2,168 were open fundoplications (OF), 9,572 were CLF, and 339 were robot-assisted laparoscopic fundoplications (RLF). CLF and RLF displayed no significance in mortality (0.1 vs. 0 %; p = 0.5489), morbidity (4.0 vs. 5.6 %; p = 0.1744), length of stay (2.8 ± 3.6 vs. 3.0 ± 3.5; p = 0.3242), and intensive care unit (ICU) cases (8.4 vs. 11.5 %; p = 0.051). However, CLF remained superior, with a lower 30-day re-admission rate (1.8 vs. 3.6 %; p < 0.05) and cost (US$7,968 ± 6,969 vs. US$10,644 ± 6,041; p < 0.05). When RLF was compared with OF, RLF had significantly improved morbidity (5.6 vs. 11 %; p < 0.05), length of stay (6.1 ± 7.2 vs. 3.0 ± 3.5 days; p < 0.05), less ICU admission (11.5 vs. 23.1 %; p <0.05) and less cost (US$10,644 ± 6,041 vs. US$12,766 ± 13,982; p < 0.05). CONCLUSIONS Current data suggests that robot-assisted NF procedures have similar patient outcomes to conventional laparoscopic NF, with the exception of added cost and higher re-admission rate. While the higher costs are expected given the new technology, increasing re-admission rates are concerning and may represent the level of experience of the surgeon as well as the robotic learning curve.
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Affiliation(s)
- Benjamin Owen
- Department of Surgery, University of Nebraska Medical Center, 985126 Nebraska Medical Center, Omaha, NE, 68198-5126, USA
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A prospective randomized study of systemic inflammation and immune response after laparoscopic nissen fundoplication performed with standard and low-pressure pneumoperitoneum. Surg Laparosc Endosc Percutan Tech 2013; 23:189-96. [PMID: 23579517 DOI: 10.1097/sle.0b013e3182827e51] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to compare changes in the systemic inflammation and immune response in the early postoperative (p.o.) period after laparoscopic Nissen fundoplication (LNF) was performed with standard-pressure and low-pressure carbon dioxide pneumoperitoneum. MATERIALS AND METHODS We studied 68 patients with documented gastroesophageal reflux disease and who underwent a LNF: 35 using standard-pressure (12 to 14 mmHg) and 33 low-pressure (6 to 8 mmHg) pneumoperitoneum. White blood cells, peripheral lymphocytes subpopulation, human leukocyte antigen-DR, neutrophil elastase, interleukin (IL)-6 and IL-1, and C-reactive protein were investigated. RESULTS A significantly higher concentration of neutrophil elastase, IL-6 and IL-1, and C-reactive protein was detected postoperatively in the standard-pressure group of patients in comparison with the low-pressure group (P<0.05). A statistically significant change in human leukocyte antigen-DR expression was recorded p.o. at 24 hours, as a reduction of this antigen expressed on monocyte surface in patients from standard group; no changes were noted in low-pressure group patients (P<0.05). CONCLUSIONS This study demonstrated that reducing the pressure of the pneumoperitoneum to 6 to 8 mm Hg during LNF is reduced p.o. inflammatory response and avoided p.o. immunosuppression.
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Tolone S, Docimo G, Del Genio G, Brusciano L, Verde I, Gili S, Vitiello C, D'Alessandro A, Casalino G, Lucido F, Leone N, Pirozzi R, Ruggiero R, Docimo L. Long term quality of life after laparoscopic antireflux surgery for the elderly. BMC Surg 2013; 13 Suppl 2:S10. [PMID: 24267446 PMCID: PMC3851040 DOI: 10.1186/1471-2482-13-s2-s10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. Methods Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. Results Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). There were 114 (36.6%) patients who filled out the SF36 questionnaire (98 in the younger group, rate: 37.4%; 16 in the elderly group, rate: 32.6%) pre- and post-operatively. There was no significant difference between the two age groups regarding preoperative PCS ( 45.6 ± 7.8 in YG vs. 44.2 ± 8.2 in EG; P = 0.51) and MCS ( 48.1 ± 10.7 in YG vs. 46.9 ± 9.2 in EG; P = 0.67). There was no significant difference between the two age groups regarding postoperative PCS (49.8 ± 11.9 in YG and 48.2 ± 9.5 in EG ; P = 0.61 and MCS (48.4 ± 10.7 in YG vs. 50.1 ± 6.9 in EG; P = 0.54). Conclusions In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.
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Incidence, mechanisms, and outcomes of esophageal and gastric perforation during laparoscopic foregut surgery: a retrospective review of 1,223 foregut cases. Surg Endosc 2013; 28:85-90. [PMID: 24013468 DOI: 10.1007/s00464-013-3167-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intraoperative perforation is a potentially major complication of laparoscopic (lap) foregut surgery. This study analyzed the incidence, mechanism, and outcomes of intraoperative perforations during these procedures in a large institutional experience. METHODS All patients who underwent lap foregut surgery including laparoscopic antireflux surgery (LARS), paraesophageal hernia (PEH) repair, Heller myotomy, and reoperative hiatal hernia (redo HH) repair at the authors' institution from August 2004 to September 2012 were reviewed retrospectively. Perforation events and postoperative outcomes were analyzed, and complications were graded by the modified Clavien system. All data are expressed as means ± standard deviations or as medians. Statistical analysis was performed using Fisher's exact test and the Mann-Whitney U test. RESULTS In this study, the repairs for 1,223 patients were analyzed (381 LARS procedures, 379 PEH repairs, 313 Heller myotomies, 150 redo HH repairs). Overall, 51 patients (4.2 %) had 56 perforations resulting from LARS (n = 4, 1 %), PEH repair (n = 7, 1.8 %), Heller myotomy (n = 18, 5.8 %), and redo HH repair (n = 22, 14.6 %). Redo HH was significantly more likely to result in perforations than LARS or PEH repair (p < 0.001). The locations of the perforations were esophageal in 13 patients (23.6 %), gastric in 40 patients (72.7 %), and indeterminate in 2 patients (3.6 %). The most common mechanisms of perforations were suture placement for LARS (75 %) and traction for PEH repair (43 %) and for Heller myotomy during the myotomy (72 %). The most redo HH perforations resulted from dissection/wrap takedown (73 %) and traction (14 %). Perforations were recognized and repaired intraoperatively in 43 cases (84 %) and postoperatively in eight cases (16 %). Perforations discovered postoperatively were more likely to require reoperation (75 vs 2 %; p < 0.001), to require more gastrointestinal and radiologic interventions (50 vs 2 %; p = 0.004), and to have higher morbidity (88 vs 26 %; p = 0.004) than perforations recognized intraoperatively. CONCLUSIONS In a high-volume center, intraoperative perforations are the most frequent with reoperative HH repair. If perforations are recognized and repaired intraoperatively, they require minimal postoperative intervention. Unrecognized perforations usually require reoperation and result in significantly greater morbidity.
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Wilshire CL, Watson TJ. Surgical management of gastroesophageal reflux disease. Gastroenterol Clin North Am 2013; 42:119-31. [PMID: 23452634 DOI: 10.1016/j.gtc.2012.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Antireflux surgery has become a well-established therapy for gastroesophageal reflux disease (GERD) and its complications. The popularization of minimally invasive surgical techniques has brought about a revolution in the use of fundoplication for the long-term management of GERD. A reliable and objective understanding of the outcomes following fundoplication is important for all physicians treating GERD, so that informed decisions can be made regarding the optimal treatment strategy for a given patient. With ongoing study, the appropriate indications for surgical intervention among the array of potential antireflux therapies will continue to be elucidated.
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Affiliation(s)
- Candice L Wilshire
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Cano-Valderrama O, Marinero A, Sánchez-Pernaute A, Domínguez-Serrano I, Pérez-Aguirre E, Torres AJ. Aortic injury during laparoscopic esophageal hiatoplasty. Surg Endosc 2013; 27:3000-2. [PMID: 23436085 DOI: 10.1007/s00464-013-2826-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 01/08/2013] [Indexed: 11/27/2022]
Abstract
A 75-year-old female patient with a type III hiatal hernia was submitted to laparoscopic mesh hiatoplasty. Soon after the last suture fixed the mesh to the left crura, a hemorrhage was observed. Conversion to open surgery was not performed. The most common sources of bleeding (liver, phrenic arteries, crura, spleen, and short gastric vessels) were discarded as the cause of the hemorrhage. The mesh was set free in order to explore the lower mediastinum. The source of the hemorrhage was identified: it was the last suture fixing the mesh to the left crura, which was found passing through the aortic wall. The hemorrhage stopped as soon as the suture was removed. When facing a hemorrhage during this kind of surgery, it is essential to be methodical to discover the source of the bleeding. First of all, the most common sources of bleeding must be checked out. Injury of the inferior vena cava must also be ruled out, because it is an uncommon but potentially lethal complication. Afterwards, the lower mediastinum must be explored. Conversion to an open approach is needed if the patient becomes unstable or the surgeon does not have enough laparoscopic skills to find and solve the bleeding. Most of the reported cases of aortic injury during laparoscopic hiatoplasty are secondary to vascular injuries during port insertion. When a suture is the cause of bleeding, the removal of the stitch should be enough to stop the bleeding. If there is a tear of the aortic wall, a patch should be employed for the repair. In conclusion, left crura and thoracic aorta are very close to one another. The surgeon must be very careful when working near the left crura, mostly in old patients with a dilated and aneurysmatic aorta.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040 Madrid, Spain.
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Bello B, Herbella FA, Allaix ME, Patti MG. Impact of minimally invasive surgery on the treatment of benign esophageal disorders. World J Gastroenterol 2012; 18:6764-70. [PMID: 23239914 PMCID: PMC3520165 DOI: 10.3748/wjg.v18.i46.6764] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/26/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Thanks to the development of minimally invasive surgery, the last 20 years have witnessed a change in the treatment algorithm of benign esophageal disorders. Today a laparoscopic operation is the treatment of choice for esophageal achalasia and for most patients with gastroesophageal reflux disease. Because the pathogenesis of achalasia is unknown, treatment is palliative and aims to improve esophageal emptying by decreasing the functional obstruction at the level of the gastro-esophageal junction. The refinement of minimally invasive techniques accompanied by large, multiple randomized control trials with long-term outcome has allowed the laparoscopic Heller myotomy and partial fundoplication to become the treatment of choice for achalasia compared to endoscopic procedures, including endoscopic botulinum toxin injection and pneumatic dilatation. Patients with suspected gastroesophageal reflux need to undergo a thorough preoperative workup. After establishing diagnosis, treatment for gastroesophageal reflux should be individualized to patient characteristics and a decision about an operation made jointly between surgeon and patient. The indications for surgery have changed in the last twenty years. In the past, surgery was often considered for patients who did not respond well to acid reducing medications. Today, the best candidate for surgery is the patient who has excellent control of symptoms with proton pump inhibitors. The minimally invasive approach to antireflux surgery has allowed surgeons to control reflux in a safe manner, with excellent long term outcomes. Like achalasia and gastroesophageal reflux, the treatment of patients with paraesophageal hernias has also seen a major evolution. The laparoscopic approach has been shown to be safe, and durable, with good relief of symptoms over the long-term. The most significant controversy with laparoscopic paraesophageal hernia repair is the optimal crural repair. This manuscript reviews the evolution of these techniques.
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Kelly ME, Gallagher TK, Smith MJ, Ridgway PF, Conlon KC. Day-Case Laparoscopic Nissen Fundoplication: A Default Pathway or Is Selection the Key? J Laparoendosc Adv Surg Tech A 2012; 22:859-63. [DOI: 10.1089/lap.2012.0170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Michael E. Kelly
- Professorial Unit, Department of Surgery, University of Dublin, Trinity College, Dublin, Ireland; The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital, Dublin, Ireland
| | - Tom K. Gallagher
- Professorial Unit, Department of Surgery, University of Dublin, Trinity College, Dublin, Ireland; The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital, Dublin, Ireland
| | - Myles J. Smith
- Professorial Unit, Department of Surgery, University of Dublin, Trinity College, Dublin, Ireland; The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital, Dublin, Ireland
| | - Paul F. Ridgway
- Professorial Unit, Department of Surgery, University of Dublin, Trinity College, Dublin, Ireland; The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital, Dublin, Ireland
| | - Kevin C. Conlon
- Professorial Unit, Department of Surgery, University of Dublin, Trinity College, Dublin, Ireland; The Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital, Dublin, Ireland
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Rosemurgy A, Paul H, Madison L, Luberice K, Donn N, Vice M, Hernandez J, Ross SB. A Single Institution's Experience and Journey with over 1000 Laparoscopic Fundoplications for Gastroesophageal Reflux Disease. Am Surg 2012. [DOI: 10.1177/000313481207800928] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There have been great advances in laparoscopic surgery for gastroesophageal reflux disease (GERD), including laparoendoscopic single-site (LESS) surgery. This study details our experience with over 1000 patients undergoing fundoplication for GERD and the journey therein. A total of 1078 patients have been prospectively followed after fundoplication. Patients scored the frequency/severity of symptoms using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). We compared the outcomes of the first and last 100 patients. Median data are reported. Of 1078 patients, 943 underwent conventional laparoscopic fundoplication and 135, most recently, underwent LESS fundoplication. Before fundoplication, patients noted frequent/severe symptoms (e.g., heartburn: frequency = 8, severity = 8). Fundoplication ameliorated frequency/severity of symptoms (e.g., heartburn: frequency = 2, severity = 0; less than preoperatively, P < 0.05). Relative to our first 100 patients, patients after LESS surgery had similar symptom control (e.g., heartburn: frequency = eight to two vs eight to zero, severity = eight to one vs six to one) but had shorter hospital stays (2 vs 1 day, P < 0.05) and had no apparent scars. Laparoscopic fundoplication provides durable and efficacious treatment for GERD; long-term symptom resolution and patient satisfaction support its continued application. The advent of LESS surgery advances surgeons’ abilities to provide safe and salutary care while promoting cosmesis.
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Affiliation(s)
| | - Harold Paul
- Department of Surgery, Tampa General Hospital, Tampa, Florida
| | - Lauren Madison
- Department of Surgery, Tampa General Hospital, Tampa, Florida
| | | | - Natalie Donn
- Department of Surgery, Tampa General Hospital, Tampa, Florida
| | - Michelle Vice
- Department of Surgery, Tampa General Hospital, Tampa, Florida
| | | | - Sharona B. Ross
- University of South Florida College of Medicine, Tampa, Florida
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Yetişir F, Salman AE, Durak D, Kiliç M. Laparoscopic fundoplication with double sided posterior gastropexy: a different surgical technique. Int J Surg 2012; 10:532-6. [PMID: 22917835 DOI: 10.1016/j.ijsu.2012.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/03/2012] [Accepted: 08/06/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Laparoscopic Nissen Fundoplication has become the gold standard surgical procedure for management of gastroesophageal reflux disease. Nissen fundoplication provides an effective barrier against reflux. The aim of this study was to evaluate early postoperative outcomes of a different surgical technique, laparoscopic fundoplication with double sided posterior gastropexy. METHODS Data of 46 patients who underwent laparoscopic fundoplication with double sided posterior gastropexy between February 2010 and December 2011 were collected. Surgically, after Nissen fundoplication was completed, 2-4 sutures were passed through the uppermost parts of the posterior and anterior wall of the gastric wrap and then passed gently 1 cm above the celiac artery from the denser fibers of uppermost part of the arcuate ligament. Demographic data, preoperative and postoperative assesments of sympthomatic and functional outcomes of patients were recorded. Length of hospital stay, operative time, early postoperative complications and complications at 1 year follow up, early recurrence rate were also recorded. RESULTS This technique resulted in good symptomatic and clinical outcomes. Only one patient out of 45 patients was reoperated. The early recurrence rate was 2.2%. CONCLUSION Laparoscopic Nissen fundoplication with double sided posterior gastropexy may prevent paraesophageal herniation. It is a reasonably feasible and effective method in surgical management of GERD.
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Affiliation(s)
- Fahri Yetişir
- Ataturk Research and Training Hospital, General Surgery Department, Turkey.
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Niebisch S, Fleming FJ, Galey KM, Wilshire CL, Jones CE, Litle VR, Watson TJ, Peters JH. Perioperative risk of laparoscopic fundoplication: safer than previously reported-analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2009. J Am Coll Surg 2012; 215:61-8; discussion 68-9. [PMID: 22578304 DOI: 10.1016/j.jamcollsurg.2012.03.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 03/05/2012] [Accepted: 03/28/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Several prospective randomized controlled trials show equal effectiveness of surgical fundoplication and proton pump inhibitor therapy for the treatment of gastroesophageal reflux disease. Despite this compelling evidence of its efficacy, surgical antireflux therapy is underused, occurring in a very small proportion of patients with gastroesophageal reflux disease. An important reason for this is the perceived morbidity and mortality associated with surgical intervention. Published data report perioperative morbidity between 3% and 21% and mortality of 0.2% and 0.5%, and current data are uncommon, largely from previous decades, and almost exclusively single institutional. STUDY DESIGN The study population included all patients in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 through 2009 who underwent laparoscopic fundoplication with or without related postoperative ICD-9 codes. Comorbidities, intraoperative occurrences, and 30-day postoperative outcomes were collected and logged into statistical software for appropriate analysis. Postoperative occurrences were divided into overall and serious morbidity. RESULTS A total of 7,531 fundoplications were identified. Thirty-five percent of patients were younger than 50 years old, 47.1% were 50 to 69 years old, and 16.8% were older than 69 years old. Overall, 30-day mortality was 0.19% and morbidity was 3.8%. Thirty-day mortality was rare in patients younger than age 70 years, occurring in 5 of 10,000 (0.05%). Mortality increased to 8 of 1,000 (0.8%) in patients older than 70 years (p < 0.0001). Complications occurred in 2.2% of patients younger than 50 years, 3.8% of those 50 to 69 years, and 7.3% of patients older than 69 years. Serious complications occurred in 8 of 1,000 (0.8%) patients younger than 50 years, 1.8% in patients 50 to 69 years, and 3.9% of those older than 69 years. CONCLUSIONS Analysis of this large cohort demonstrates remarkably low 30-day morbidity and mortality of laparoscopic fundoplication. This is particularly true in patients younger than 70 years, who are likely undergoing fundoplication for gastroesophageal reflux disease. These data suggest that surgical therapy carries an acceptable risk profile.
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Affiliation(s)
- Stefan Niebisch
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA
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Endoscopic full-thickness plication versus laparoscopic fundoplication: a prospective study on quality of life and symptom control. Surg Endosc 2011; 26:1063-8. [PMID: 22042589 DOI: 10.1007/s00464-011-1999-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 10/10/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Endoscopic antireflux techniques have emerged as alternative therapies for gastroesophageal reflux disease (GERD). Endoscopic plication receives continuing interest as an effective and safe procedure. This treatment option has not been the subject of comparison with well-established operative therapies to date. The present study aimed at comparatively evaluating the effectiveness of endoscopic plication and laparoscopic fundoplication in terms of quality of life and symptom control. METHODS Between October 2006 and April 2010, 60 patients with documented GERD were randomly assigned to undergo either endoscopic plication or laparoscopic fundoplication. Quality-of-life scores and symptom grading were recorded before treatment and at 3- and 12-month follow-up. Outcomes were compared with the statistical significance set at a p value of 0.05. RESULTS Twenty-nine patients from the endoscopic group and 27 patients from the operative group were available at follow-up. Quality-of-life scores showed a substantial and similar increase for both groups after treatment. Symptoms of heartburn (p < 0.02), regurgitation (p < 0.004), and asthma (p = 0.03) were significantly improved in the endoscopic group, whereas laparoscopic fundoplication was more effective in controlling symptoms of heartburn (p < 0.01) and regurgitation (p < 0.05) compared to the endoscopic procedure. CONCLUSIONS Endoscopic plication and laparoscopic fundoplication resulted in significant symptom improvement with similar quality-of-life scores in a selected patient population with GERD, whereas operative treatment was more effective in the relief of heartburn and regurgitation at the expense of higher short-term dysphagia rates.
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Short esophagus: selection of patients for surgery and long-term results. Surg Endosc 2011; 26:704-13. [DOI: 10.1007/s00464-011-1940-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/31/2011] [Indexed: 12/13/2022]
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Varban OA, McCoy TP, Westcott C. A comparison of pre-operative comorbidities and post-operative outcomes among patients undergoing laparoscopic nissen fundoplication at high- and low-volume centers. J Gastrointest Surg 2011; 15:1121-7. [PMID: 21557016 DOI: 10.1007/s11605-011-1492-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 03/16/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Commonly cited data promoting laparoscopic Nissen fundoplication (LNF) as safe and efficacious are typically published by single centers, affiliated with teaching institutions with a high volume of cases, but LNF is not universally performed at these hospitals. The purpose of this study is to assess where these procedures are being done and to compare pre-operative comorbidities and post-operative outcomes between high-and low-volume centers using a state-wide inpatient database. METHODS This is a retrospective study using data from the North Carolina Hospital Association Patient Data System. Selected patients include adults (>17 years old) that have undergone laparoscopic Nissen fundoplication for gastroesophageal reflux disease as an inpatient from 2005 to 2008. Patients that underwent operative management for emergent purposes or had associated diagnoses of esophageal cancer or achalasia were excluded from the study. High-volume centers were defined as institutions that performed ten or more LNFs per year averaged over a period of 4 years. Comparative statistics were performed on comorbidities and complications between high- and low-volume centers. RESULTS A total of 1,019 patients underwent LNF for GERD in North Carolina between 2005 and 2008 in the inpatient setting. High-volume centers performed 530 LNFs (52%) while low-volume centers performed 489 LNFs (48%). Patients at high-volume centers were older (median 52.5 years old vs. 49.0 years old, p = 0.019), had a higher incidence of diabetes (13.4% vs. 8.8%, p = 0.026), chronic obstructive pulmonary disease (5.1% vs. 2.0 %, p = 0.015), hyperlipidemia (9.6% vs. 4.7%, p = 0.004), and cystic fibrosis (2.8% vs. 0.8%, p = 0.03). Patients with a history of transplantation were also more likely to undergo LNF at a high-volume center (15.8% vs. 1.6%, p < 0.0001). There were no deaths among the two groups and also no difference between median length of stay (2.7 days for high-volume center vs. 2.6 days for low-volume center). Low-volume centers had a higher incidence of intraoperative accidental puncture or laceration (3.3% vs. 0.9%, p = 0.017) while high-volume centers had a higher incidence of atelectasis (5.3% vs. 2.5%, p = 0.031). CONCLUSION A significant proportion of the LNFs in North Carolina are performed at low-volume centers. High-volume centers perform LNF on older patients with more comorbidities. Low-volume centers have three times more accidental perforations, yet there is no detectable difference in mortality or median length of stay. It is impossible to tell if these perforations are managed at these low-volume centers or transferred to facilities with a higher level of care. These findings argue for regionalization of LNF and for a reevaluation of the global safety of this operation.
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Affiliation(s)
- Oliver Adrian Varban
- Department of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, 27157 Winston-Salem, NC, USA
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A randomized controlled trial of laparoscopic Nissen fundoplication versus proton pump inhibitors for the treatment of patients with chronic gastroesophageal reflux disease (GERD): 3-year outcomes. Surg Endosc 2011; 25:2547-54. [DOI: 10.1007/s00464-011-1585-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 01/10/2011] [Indexed: 12/21/2022]
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Devenney-Cakir B, Tkacz J, Soto J, Gupta A. Complications of esophageal surgery: role of imaging in diagnosis and treatments. Curr Probl Diagn Radiol 2011; 40:15-28. [PMID: 21081209 DOI: 10.1067/j.cpradiol.2009.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Esophageal surgery is a common and integral component in the management of hiatal hernias, esophageal carcinoma, and esophageal perforation. Understanding the expected postsurgical imaging features of these common esophageal surgeries and postoperative complications is essential. Image-guided intervention can be used to aid the surgeon in the management of many post esophageal surgical complications. We discuss the imaging features of the postoperative esophagus and the use of imaging, including fluoroscopy and computed tomography, in the diagnosis of post esophageal surgical complications and treatment.
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Herniation of the Anterior Wall of the Stomach into a Congenital Postdiaphragmatic Space: An Unusual Complication following Laparoscopic Nissen Fundoplication. Case Rep Med 2010; 2010:893017. [PMID: 21113305 PMCID: PMC2990024 DOI: 10.1155/2010/893017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 07/18/2010] [Accepted: 10/26/2010] [Indexed: 11/17/2022] Open
Abstract
Postoperative herniation of the stomach into potential spaces is a rare but serious complication of Nissen fundoplication. We report a 55-year-old female who presented with persistent vomiting shortly following laparoscopic Nissen fundoplication. At laparotomy, the anterior wall of the stomach was noted to be herniating into a congenital space behind the diaphragm. Anterior gastropexy was performed following the reduction of the herniating gastric segment. A high index of suspicion followed by aggressive and timely intervention is necessary to diagnose and manage postoperative gastric herniation and reduce the subsequent morbidity and mortality.
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Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 2010; 24:2647-2669. [PMID: 20725747 DOI: 10.1007/s00464-010-1267-8] [Citation(s) in RCA: 240] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/27/2010] [Indexed: 02/06/2023]
Affiliation(s)
- Dimitrios Stefanidis
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA.
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Golkar F, Morton C, Ross S, Vice M, Arnaoutakis D, Dahal S, Hernandez J, Rosemurgy A. Medical comorbidities should not deter the application of laparoscopic fundoplication. J Gastrointest Surg 2010; 14:1214-9. [PMID: 20552292 DOI: 10.1007/s11605-010-1240-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 05/25/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Laparoscopic Nissen fundoplication offers significant improvement in gastroesophageal reflux disease (GERD) symptom severity and frequency. This study was undertaken to determine the impact of preoperative medical comorbidities on the outcome and satisfaction of patients undergoing fundoplication for GERD. METHODS Prior to fundoplication, patients underwent esophageal motility testing and 24-h pH monitoring. Before and after fundoplication, the frequency and severity of reflux symptoms were scored using a Likert scale. Medical comorbidities were classified by organ systems, and patients were assigned points corresponding to the number of medical comorbidities they had. In addition, all patients were assigned Charlson comorbidity index (CCI) scores according to the medical comorbidities they had. A medical comorbidity was defined as a preexisting medical condition, not related to GERD, for which the patient was receiving treatment. Analyses were then conducted to determine the impact of medical comorbidities as well as CCI score on overall outcome, symptom improvement, and satisfaction. RESULTS Six hundred and ninety-six patients underwent fundoplication: 538 patients had no medical comorbidities and 158 patients had one or more medical comorbidities. Preoperatively, there were no differences in symptom severity and frequency scores between patients with or without medical comorbidities. Postoperatively, all patients had improvement in their symptom severity and frequency scores. There were no differences in postoperative symptom scores between the patients with medical comorbidities and those without. The majority of patients were satisfied with their overall outcome; there was no relationship between the number of medical comorbidities and satisfaction scores. These findings were mirrored when patients' CCI scores were compared with satisfaction, overall outcome, and symptom improvement. CONCLUSION These results promote further application of laparoscopic Nissen fundoplication, even for patients with medical comorbidities.
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Affiliation(s)
- Farhaad Golkar
- University of South Florida and Tampa General Hospital Digestive Disorders Center, Tampa, FL, USA
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van Beek DB, Auyang ED, Soper NJ. A comprehensive review of laparoscopic redo fundoplication. Surg Endosc 2010; 25:706-12. [DOI: 10.1007/s00464-010-1254-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 06/30/2010] [Indexed: 01/11/2023]
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Broeders JA, Draaisma WA, Bredenoord AJ, Smout AJ, Broeders IA, Gooszen HG. Long-term outcome of Nissen fundoplication in non-erosive and erosive gastro-oesophageal reflux disease. Br J Surg 2010; 97:845-52. [PMID: 20473997 DOI: 10.1002/bjs.7023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Non-erosive (NERD) and erosive (ERD) gastro-oesophageal reflux disease (GORD) show similar severity of symptoms and impact on quality of life (QoL). Prospective data on long-term outcomes of antireflux surgery in NERD are lacking. METHODS Subjective and objective 5-year outcomes of Nissen fundoplication were compared in 96 patients with NERD and 117 with ERD, operated on for proton-pump inhibitor (PPI)-refractory GORD. RESULTS Preoperative and postoperative QoL, PPI use, acid exposure time, symptom-reflux correlation, lower oesophageal sphincter (LOS) pressure and reoperation rates were similar in the two groups. At 5 years, relief of reflux symptoms was similar (NERD 89 per cent versus ERD 96 per cent), PPI use showed a similar reduction (82 to 21 per cent versus 81 to 15 per cent respectively; both P < 0.001) and QoL score improved equally (50.3 to 65.2 (P < 0.001) versus 52.0 to 60.7 (P = 0.016)). Five patients with NERD developed erosions after surgery; oesophagitis healed in 87 per cent of patients with ERD. Reduction in total acid exposure time (NERD 12.7 to 2.0 per cent versus ERD 13.8 to 2.9 per cent; both P < 0.001) and increase in LOS pressure (1.3 to 1.8 kPa versus 1.2 to 1.8 kPa; both P < 0.001) were similar. The reintervention rate was comparable (NERD 15 per cent versus ERD 12.8 per cent). CONCLUSION Patients with PPI-refractory NERD and ERD benefit equally from Nissen fundoplication. The absence of mucosal lesions on endoscopy in patients with proven PPI-refractory reflux disease is not a reason to refrain from antireflux surgery.
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Affiliation(s)
- J A Broeders
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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