Relationship of a Satisfactory Outcome to Normalization of Delayed Gastric Emptying After Nissen Fundoplication (original) (raw)
Related papers
Late Evaluation of Patients Operated for Gastroesophageal Reflux Disease by Nissen Fundoplication
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
Surgical treatment of GERD by Nissen fundoplication is effective and safe, providing good results in the control of the disease. However, some authors have questioned the efficacy of this procedure and few studies on the long-term outcomes are available in the literature, especially in Brazil. To evaluate patients operated for gastro-esophageal reflux disease, for at least 10 years, by Nissen fundoplication. Thirty-two patients were interviewed and underwent upper digestive endoscopy, esophageal manometry, 24 h pH monitoring and barium esophagogram, before and after Nissen fundoplication. Most patients were asymptomatic, satisfied with the result of surgery (87.5%) 10 years after operation, due to better symptom control compared with preoperative and, would do it again (84.38%). However, 62.5% were in use of some type of anti-reflux drugs. The manometry revealed lower esophageal sphincter with a mean pressure of 11.7 cm H2O and an average length of 2.85 cm. The average DeMeester ind...
Background/Aim: Gastroesophageal reflux disease (GERD) is one of the most chronic disorders of gastrointestinal tract; 40% of patients with symptomatic GERD; develop complications with the potential sequels of impaired quality of life. The etiology of GERD is multifactorial. Nissen fundoplication is the most widely performed anti-reflux operation worldwide and is considered the gold standard. Recently, proximal gastric vagotomy has to been open added Nissen fundoplication for surgery of GERD. The aim of this study is to compare between Nissen fundoplication with added proximal gastric vagotomy and Nissen alone for treatment of GERD.
Annals of Surgery, 1986
One hundred consecutive patients had a primary Nissen fundoplication for gastroesophageal reflux disease. None of the patients had previous gastric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91% effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p less than 0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39% (p less than 0.01). Second, shortening the length of the fundoplication decreased the incidence of persistent dysphagia from 21 to 3% (p less than 0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71% (p less than 0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.
American Journal of Surgery, 2005
Background: Severe gastroesophageal reflux disease may result in acquired esophageal dysmotility. The correct surgical approach to associated gastroesophageal reflux disease and dysmotility is controversial, in particular whether the "gold-standard" total fundoplication of Nissen is appropriate compared with partial fundoplication. Our unit has performed total fundoplication for all patients, irrespective of esophageal motility, and this article describes that experience. Methods: Ninety-eight patients undergoing antireflux surgery were divided into 2 groups. Group 1 (n ϭ 60) consisted of patients with normal esophageal motility, and group 2 (n ϭ 38) had dysmotility. All patients underwent preoperative and postoperative manometry, 24-hour pH testing, symptom scoring, and quality-of-life assessment. Results: The median postoperative acid score was not significantly different between groups 1 and 2. Eighty-eight percent of patients with normal motility and 89% of patients with dysmotility had no symptoms or minor symptoms, with a significant improvement in quality of life 6 months after surgery. There was a significant increase in esophageal wave amplitude in both groups, and 20 patients (53%) in the dysmotility group reverted to normal motility after surgery. Recurrent symptoms were associated with postoperative abnormal pH profiles in 5 patients from group 1 and 3 from group 2. Conclusions: Preoperative dysmotility is not a contraindication for total fundoplication. Postoperative acid control is associated with improved esophageal clearance and symptoms.
The American Journal of …, 1994
BACKGROUND: Nissen fundoplication has been shown to be superior to medical treatment in the management of severe or complicated gastroesophageal reflux disease (GERD). Rapid advances in minimally invasive surgical techniques and recognition of the advantages of reduced incision-related morbidity have fostered application of laparoscopic techniques to antireflux surgery. A prospective evaluation of 70 patients undergoing laparoscopic Nissen fundoplication for severe GERD was undertaken.
Journal of Gastrointestinal Surgery, 2014
Background Ineffective esophageal motility (IEM) in patients with gastroesophageal reflux disease includes three different subsets that may affect symptom profiles. Our aim was to assess symptoms and functional outcome in patients with erosive esophagitis according to different subsets of IEM, before and after Nissen fundoplication (NF). Methodology A retrospective study with prospective follow-up of 72 patients with reflux esophagitis and IEM in whom open NF was performed. Based on principal manometric esophageal body motility disorder, patients were divided in three groups: predominantly low-amplitude (LAC, N=38), non-propulsive (NPC, N=18), and simultaneous low-amplitude esophageal contractions (SC, N=16). Patients underwent symptomatic questionnaire and stationary esophageal manometry before and 6 months, 1 year, and 3 years after surgery. Results Preoperatively, patients in NPC and SC groups had higher mean scores of dysphagia, without statistical significance as opposed to the LAC group (p=0.239). Postoperative dysphagia occurred in 36 patients, without statistical significance between groups regarding dysphagia grades (p=0.390). A longer duration of postoperative dysphagia was noted in the SC group (p<0.05). Improvement of nadir values of contraction amplitudes in distal esophagus occurred postoperatively in all groups, significantly higher in LAC (p<0.001). Conclusion Three years after NF, successful symptomatic and functional outcome was achieved in analyzed groups of patients with erosive esophagitis regardless of IEM subtype.
Long-term results of nissen fundoplication in reflux esophagitis without strictures
Digestive Diseases and Sciences, 1992
The present paper evaluates the efficiency of Nissen fundoplication as an antireflux technique in a series of 51 patients with different grades of esophagitis. Follow-up time averaged 6.6 years. The evaluation includes a clinical assessment, endoscopic study, and 24-hr pH monitoring. The results reveal an acceptable rate of recurrences, with clinical (9.8%) being less frequent than endoscopic (13.7%) or pH-metric (19.6%) recurrences. Side effects appeared in 37.3% of the patients (mainly inability to belch or vomit, and postprandial fullness), which were mild and transitory in most cases. Nissen fundoplication proved effective in controlling long-term gastroesophageal reflux, as over 80% of the patients presented an excellent-to-good clinical situation, without or with minimal digestive consequences.
Gastroenterology, 2017
the proximal esophagus. The procedure was monitored via fluoroscopy, and a Merit pressure transducer, connected to a PowerLab system, using LabChart software, measured the pressure exerted on the balloon. This procedure was performed at baseline, immediately post-implant and at 42 days. Video fluoroscopy was also performed at those time intervals with awake pigs eating barium-laced food to assess bolus transport through the Ω-Cuff and to check for device migration. Necropsies were performed in 6 animals at 42 days. 90, 180, and 360-day data are pending. RESULTS: Video fluoroscopy demonstrated that food boluses traveled through the Ω-Cuff without hesitation. An immediate rise in yield pressure was observed with the Ω-Cuff compared to baseline (25.4 mmHg baseline vs 41.9 mmHg immediately post-op; p < .001). Yield pressure doubled at 42 days post-implant (54.3 mmHg) from baseline (p < .001 vs baseline and vs immediately post-op). Necropsies in 6 pigs at 42-days showed the device was covered by a thin parietal pleura with thicker fibrosis on the device ends. All vital signs of the pigs remained normal as did appetite, eating, weight gain and behavior prior to sacrifice. There was no device migration. CONCLUSION: Data thus far demonstrates that the Omega cuff augments the LES in a pig model as shown by a consistent increase in GEJ yield pressure. The device includes an open side allowing for more normal physiology of the LES such as belching/vomiting and should minimize dysphasia. The Ω-Cuff appears to be a promising implant to augment the LES for mitigating GERD analogous to partial fundoplication and is designed to be simpler, more durable and easier to apply.
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...