Comparison of open and laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease in Taiwanese (original) (raw)
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Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD
Surgical Endoscopy and Other Interventional Techniques, 1997
Background: Laparoscopic antireflux surgery is currently a growing field in endoscopic surgery. The purpose of the Consensus Development Conference was to summarize the state of the art of laparoscopic antireflux operations in June 1996. Methods: Thirteen internationally known experts in gastroesophageal reflux disease were contacted by the conference organization team and asked to participate in a Consensus Development Conference. Selection of the experts was based on clinical expertise, academic activity, community influence, and geographical location. According to the criteria for technology assessment, the experts had to weigh the current evidence on the basis of published results in the literature. A preconsensus document was prepared and distributed by the conference organization team. During the E.A.E.S. conference, a consensus document was prepared in three phases: closed discussion in the expert group, public discussion during the conference, and final closed discussion by the experts. Results: Consensus statements were achieved on various aspects of gastroesophageal reflux disease and current laparoscopic treatment with respect to indication for operation, technical details of laparoscopic procedures, failure of operative treatment, and complete postoperative follow-up evaluation. The strength of evidence in favor of laparoscopic antireflux procedures was based mainly on type II studies. A majority of the experts (6/10) concluded in an overall assessment that laparoscopic antireflux procedures were better than open procedures. Conclusions: Further detailed studies in the future with careful outcome assessment are necessary to underline the consensus that laparoscopic antireflux operations can be recommended.
Surgical Endoscopy, 2003
Background: Recent reports have suggested that antireflux surgery should not be advised with the expectation of elimination of medical treatment. We reviewed our results with laparoscopic fundoplication as a means of eliminating the symptoms of gastroesophageal reflux disease (GERD), improving quality of life, and freeing patients from chronic medical treatment for GERD. Methods: A total of 297 patients who underwent laparoscopic fundoplication (Nissen, n = 252; Toupet, n = 45) were followed for an average of 31.4 months. Preoperative evaluation included endoscopy, barium esophagram, esophageal manometry, and 24-h pH analysis. A preoperative and postoperative visual analogue scoring scale (0-10 severity) was used to evaluate symptoms of heartburn, regurgitation, and dysphagia. A GERD score (2-32) as described by Jamieson was also utilized. The need for GERD medications before and after surgery was assessed. Results: At 2-year follow-up, the average symptom scores decreased significantly in comparison to the preoperative values: heartburn from 8.4 to 1.7, regurgitation from 7.2 to 0.7, and dysphagia from 3.7 to 1.0. The Jamieson GERD score also decreased from 25.7 preoperatively to 4.1 postoperatively. Only 10% of patients were on proton pump inhibitors (PPI) at 2 years after surgery for typical GERD symptoms. A similar percentage of patients (8.7%) were on PPI treatment for questionable reasons, such as Barrett's esophagus, ''sensitive'' stomach, and irritable bowel syndrome. Seventeen patients (5.7%) required repeat fundoplication for heartburn (n = 9), dysphagia (n = 5), and gas/ bloating (n = 3). Conclusions: Laparoscopic fundoplication can successfully eliminate GERD symptoms and improve quality of life. Significant reduction in the need for chronic GERD medical treatment 2 years after antireflux surgery can be anticipated.
Early experiences of minimally invasive surgery to treat gastroesophageal reflux disease
Journal of the Korean Surgical Society, 2013
There are fewer patients with gastroesophageal reflux disease (GERD) in Korea compared with Western countries. The incidence of GERD has increased in recent years however, concerning many physicians. Here, we report our early experiences of using a recently introduced method of laparoscopic antireflux surgery for the treatment of GERD in Korean patients. Fifteen patients with GERD were treated using antireflux surgery between May 2009 and February 2012 at the University of Ulsan College of Medicine and Asan Medical Center. Laparoscopic Nissen fundoplication with 360° wrapping was performed on all patients. Eleven male and four female patients were evaluated and treated with an average age of 58.1 ± 14.1 years. The average surgical time was 118.9 ± 45.1 minutes, and no complications presented during surgery. After surgery, the reflux symptoms of each patient were resolved; only two patients developed transient dysphagia, which resolved within one month. One patient developed a 6-cm h...
Surgical Treatment of Gastroesophageal Reflux Disease
Background Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the USA, and its prevalence is increasing worldwide. Lifestyle modifications and proton pump inhibitors (PPI) therapy are effective in the majority of patients and remain the mainstay of treatment of GERD. However, some patients will need surgical intervention because they have partial control of symptoms, do not want to be on long-term medical treatment, or suffer complications related to PPI therapy. Aims The aim of this study was to review the available evidence that supports laparoscopic antireflux surgery, and to study the effect of surgical therapy on the natural history of GERD. Results The key elements for the success of antireflux surgery are proper patient selection, careful analysis of the indications for surgery, complete pre-operative work-up, and proper execution of the surgical technique. Conclusions When the key elements are respected, antireflux surgery is very effective in controlling GERD, and it is associated to minimal morbidity and mortality.
Trends in laparoscopic anti-reflux surgery: a Korea nationwide study
Surgical Endoscopy, 2020
Background In 2014, the results derived from the nationwide data of the Korean Anti-reflux Surgery Study (KARS) demonstrated short-term feasibility and safety of anti-reflux surgery. This study aimed to update the longer-term safety and feasibility of laparoscopic anti-reflux surgery up to 1-year follow-up with the KARS nationwide cohort. Methods The data of 310 patients with GERD who received anti-reflux surgery up to 2018 were analyzed. Baseline patient characteristics, postoperative symptom resolution, and postoperative complications were evaluated at postoperative 3 months and 1 year using the questionnaire designed by KARS. We divided the patients into two groups according to the operation period (up to and after 2014) to identify changes in the trends of the characteristics of surgical patients and operative qualities. Results The typical preoperative symptoms were present in 275 patients (91.7%), and atypical symptoms were present in 208 patients (71.0%). Ninety-seven (35.5%) and 124 patients (46.1%) had inadequate PPI responses and hiatal hernia, respectively. At postoperative 1 year, typical and atypical symptoms were either completely or partially controlled in 90.3% and 73.5.0% of patients, respectively. Moderate-to-severe dysphagia, inability to belch, gas bloating, and flatulence at postoperative 1 year were identified in 23.5%, 29.4%, 23.2%, and 22.0% of patients, respectively. The number of surgical patients continuously increased from 2011 to 2018 in Korea. The proportion of patients with hiatal hernia and comorbidities increased (p < 0.01, p = 0.053), and the operation time decreased significantly (p < 0.01) in the late period (2015-2018) as compared with the early period (2011-2014). Symptom control and complication rate were equivalent between the two periods. Conclusions Anti-reflux surgery was effective with > 90% of typical symptom resolution and posed a comparable postoperative complication rate with those in Western studies with mid-term to long-term follow-up. This result supports the feasibility and safety of anti-reflux surgery as a treatment for GERD in the Korean population.
Hellenic Journal of Surgery, 2016
Gastro-esophageal reflux disease (GERD) is a very common medical disease. There is no consensus for optimal management of GERD. Proton pump inhibitors (PPI) are the most effective drug treatment for GERD. The number of antireflux procedures is on the rise, partly due to increased patient's expectations, and partly due to the advancements in minimal access surgery. There are few controversies surrounding role of laparoscopic fundoplication in the management of GERD, like whether surgery is superior to PPI; which modality is better, laparoscopic or open; whether complete wrap is better than partial, and whether division of short gastric vessels provides any advantage or not. This review article was undertaken to evaluate the role of laparoscopic fundoplication in the management of GERD and to find out answers to these controversial questions.
The Moldovan Medical Journal, 2022
Background: Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. The patient who does not respond to the empiric antisecretory treatment, with alarming symptoms, or referred to surgery should undergo an esophagogastroduodenoscopy (EGD). Material and methods: This was a retrospective and descriptive study of patients with GERD admitted for antireflux laparoscopic surgery from 2012 to 2019. All endoscopic data were analyzed with the following variables: age, gender, reflux esophagitis and its severity, esophageal ulcers and strictures, Shatzky's ring, Barrett's esophagus (BE), incompetence of the esogastric junction; hiatal hernia. Results: A total of 152 patients were included in the study. The age of the patients ranged from 19 to 76 years, averaging 52 years. Among them, 97 (63.8%) were women and 55 (35.38%) men. A wide variety of endoscopic features has been found: non-erosive GERD (6.57%); reflux esophagitis (Savary-Miller)-I (21.05%), II (44.07%), III (23.68%); esophageal ulcer (1.31%), BE (1.97%). The majority of patients present axial hiatal hernia (92.76%) corresponding to Hill grade IV incompetence of the flap valve. Hill grade III was present in 4.6% of cases, grade II-2.63%. Conclusions: The patients with GERD may have a wide range of endoscopic features (from normal to esophagitis, hiatal hernia, strictures and EB). Considering the multitude of data provided by endoscopic examination in patients with GERD, it can be certainly stated that EGD is one of the most important investigations in these patients, and is mandatory in those selected for surgical treatment.