Repair of 104 Failed Anti-Reflux Operations (original) (raw)
Related papers
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.
Objectives: To determine the burden of gastroesophageal reflux disease (GERD) on patients' quality of life (QOL) and the extent of change imposed by GERD laparoscopic surgical correction. Patients & Methods: The current study included 52 patients presenting with symptomatic GERD that was not adequately controlled with medical treatment. After clinical examination, all patients underwent upper gastrointestinal endoscopy, esophageal manometry to estimate lower esophageal sphincter (LES) pressure and were asked to complete the items of the gastroesophageal reflux disease impact scale (GIS) questionnaire and total score was calculated. Laparoscopic hiatal defect closure through crural approximation using stitches and circumferential placement of polypropylene mesh fixed to both crura, and then 360o fundoplication was performed. Operative and postoperative (PO) data were collected. GIS questionnaire and esophageal manometry were repeated 8-weeks and 6 months PO, respectively. Results: All patients passed smooth intraoperative course without complications or need for laparotomy. Mean operative time was 60.9±12.6 minutes, mean time till 1st ambulation and oral intake was 5.4±1.2 hours and 9.5±1.2 hours, respectively. Mean duration of hospital stay was 27.7±9.8 hours and mean duration till attaining full daily activities was 6.8±2.4 days. All patients showed significant improvement of the individual items of GIS questionnaire compared to preoperative scores with significantly higher total PO score compared to preoperative total score. PO manometeric measurements of LES pressure were significantly higher compared to preoperative pressure measures. Conclusion: Laparoscopic anti-reflux surgery (LARS) with mesh repair of hiatal hernia is a safe and effective procedure for management of GERD with significant improvement of patients' QOL. Keywords: Laparoscopic anti-reflux surgery, Gastroesophageal reflux disease, Quality of life
Surgical Endoscopy, 2006
A strong link exists between gastroesophageal reflux disease (GERD) and airway diseases. Surgical therapy has been recommended as it is more effective than medical therapy in the short term, but there is little data on the effectiveness of surgery long-term. We analyzed the long-term response of GERD-related airway disease after laparoscopic anti-reflux surgery (LARS). Methods: In 2004, we contacted 128 patients with airway symptoms and GERD who underwent laparoscopic antireflux surgery (LARS) between 12/1993 and 12/ 2002. At median follow-up of 53 months (19-110 mo) we studied the effects on symptoms, esophageal acid exposure, and medication use and we analyzed the data to determine predictors of successful resolution of airway symptoms. Results: Cough, hoarseness, wheezing, sore throat, and dyspnea improved in 65-75% of patients. Heartburn improved in 91 % (105/116) of patients and regurgitation in 92% (90/98). The response rate for airway symptoms was the same in patients with and without heartburn. Almost every patient took proton pump inhibitors (PPIs) preoperatively (99%, 127/128) and 61% (n = 78) were taking double or triple dose. Postoperatively, 33% (n = 45) of patients were using daily antiacid therapy but no one was on double dose. The only factor that predicted a successful surgical outcome was the presence of abnormal reflux in the pharynx as determined by 24-hour pharyngeal pH monitoring. One hundred eleven (87%) patients rated their results as excellent (n = 78, 57%) or good (n = 33, 24%). Conclusion: LARS provides an effective and durable barrier to reflux, and in so doing improves GERD-related airway symptoms in 70% of patients and improves typical GERD symptoms in 90% of patients. Pharyngeal pH monitoring identifies those patients more likely to benefit from LARS, but better diagnostic tools are needed to improve the response of airway symptoms to that of typical esophageal symptoms.
STUDY OF EFFECTIVENESS OF LAPAROSCOPIC FUNDOPLICATION IN GERD
IJBAMR, 2019
Gastro-esophageal reflux disease (GERD) is one of the most prevalent benign disorders of the upper gastrointestinal tract and involves a wide spectrum of disorders in which the reflux of gastric content leads to troublesome symptoms and/or lesions to the oesophageal mucosa requiring longterm medical management. Laparoscopic Nissen’s fundoplication was done on 30 patients of study group for a period of 2 years (Nov 2015 to Oct 2017) of symptomatic GERD with hiatus hernia. Visick score improved from an average of 3.60 preoperatively to an average of 1.27 postoperatively on follow up. Mean endoscopic grading preoperatively was 2.73 which reduced postoperatively to 1.13. P<.05 shows there is significant difference between pre op and post op score by doing Wilcoxon signed rank test. Laparoscopic Nissen's fundoplication is highly effective in the management of GERD with comparable improvement in symptomatic and objective scoring.
Langenbeck's Archives of Surgery, 2008
Background and aims Symptoms of gastroesophageal reflux disease (GERD) are common in the general population. Although the results of laparoscopic fundoplication are well documented, there have been no reports on the operative outcome in patients refractory to or with only partial response to medical therapy for GERD. Patients-methods Thirty-two patients with GERD, whose continuous high doses of medical treatment with protonpump inhibitors produced no or only partial symptom relief, underwent laparoscopic Nissen fundoplication. Symptoms were evaluated with a standardized questionnaire preoperatively and 12 months after surgery. Results The complete follow-up evaluation was obtained in 30 out of the 32 patients. The main symptoms before surgery were regurgitation (93%), heartburn (60%), epigastric pain (47%), and globus sensation (47%). All patients were relieved from heartburn, vomiting, and globus sensation. Dysphagia was relieved in 75% of the patients and regurgitation in 86%. Dysphagia as a new symptom occurred in 9%. The overall morbidity rate was 16%. Patient satisfaction rate was 87%. Conclusion Laparoscopic fundoplication seems to be an effective treatment for severe, drug-resistant GERD. The high patient satisfaction rate and the positive therapeutic response in 95% of patients justify this procedure in this strictly selected group of patients.
Benha Journal of Applied Sciences, 2021
1 General Surgery, General Surgery, Dept., Faculty of Medicine, Benha Univ., Benha, Egypt 2 General Surgery, Dept., Faculty of Medicine, Zagazig Univ., Zagazig, Egypt E-mail:boshradarwish2020@icloud.com Abstract Background: GERD is a very common disorder and can be managed effectively in a large number of patients with combination of life style modifications and appropriate medical therapy. Managing refractory GERD, which can be seen in up to 40% of the patients receiving PPI once daily, can be challenging. The best initial approach is optimization of PPI therapy. A careful history and use of investigative tools can help identify the contributing factors for PPI failure. Management of patients with GERD who are not responding to medical treatment represents a clinical dilemma. Laparoscopic anti-reflux surgery, especially Nissen fundoplication, is validated for management of PPI-responsive patients. However, the role of LNF for management of poor responders to PPI is controversial. S...
Reoperative Laparoscopic Anti-Reflux Surgery
CSurgeries, 2016
Background. Laparoscopic antireflux surgery (LAP) is becoming increasingly used for the surgical treatment of medical recalcitrant gastroesophageal reflux disease (GERD). We sought to determine the utility of remedial LAP approaches to antireflux surgery. Methods. From March 1996 to December 1998 or open antireflux procedure (n = 1) and/or troublesome postfundoplication complications (dysphagia 6, gas bloat 4). The remedial LAP surgery consisted of conversion from Nissen to Toupet fundoplication to manage dysphagia or gas bloat symptoms (n = 7), revision of LAP Nissen fundoplication (n = 7) and LAP revision of a failed open Nissen fundoplication (n = 1) for recurrent reflux.
Guidelines for surgical treatment of gastroesophageal reflux disease
Surgical Endoscopy, 2010
The guidelines for the surgical treatment of gastroesophageal reflux disease (GERD) are a series of systematically developed statements to assist physicians and patient decisions about the appropriate use of laparoscopic surgery for GERD. The statements included in this guideline are the product of a systematic review of published literature on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted and expert opinion sought where the evidence is lacking. This is an update of previous guidelines on this topic (last revision 06/2001) as new information has accumulated.