Redo Surgery after Failure of Antireflux Surgery (original) (raw)
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Long-term results of redo gastro-esophageal reflux disease surgery☆
European Journal of Cardio-Thoracic Surgery, 2008
Objective: To review the long-term results of redo gastro-esophageal reflux disease (GERD) surgery with special emphasis on residual acidsuppressing medications, pH monitoring results, and quality of life. Methods: Retrospective analysis of 52 patients (24 males) who underwent redo GERD surgery between 1986 and 2006 through a transthoracic (n = 14), or a transabdominal (n = 38) approach. Indications were recurrent GERD in 41 patients, and complication of the initial surgery in 11. Quality of life was evaluated by telephone enquiry using a validated French questionnaire (reflux quality score, RQS). Results: Postoperative complications occurred in 18 patients (35%), resulting in one death (2%). Reoperation was required in seven patients. At 1 year, 26 patients (51%) had 24 h pH monitoring, among whom 2 (8%) were proved to have recurrence of GERD. RQS values were calculated in 38 patients with a mean follow-up of 113 months. Fifty percent of this subgroup had a RQS value beyond 26/32, indicating an excellent quality of life. Among these 38 patients, 20 (53%) had acid-suppressing medications whatever their RQS values. Patients who underwent transthoracic GERD surgery had the highest RQS values ( p = 0.02), a lower rate of complications ( p = 0.06) and a lower rate of reoperation ( p = 0.04). Conclusion: Our experience confirms that selection of candidates for redo GERD surgery is a challenging issue. A transthoracic approach seems to produce better results and lower rates of complications. #
Gastroesophageal Reflux Disease and Antireflux Surgery—What Is the Proper Preoperative Work-up?
Journal of Gastrointestinal Surgery, 2012
Background Many surgeons feel comfortable performing antireflux surgery (ARS) on the basis of symptomatic evaluation, endoscopy, and barium esophagography. While esophageal manometry is often obtained to assess esophageal peristalsis, pH monitoring is rarely considered necessary to confirm the diagnosis of gastroesophageal reflux disease (GERD). Aims The aim of this study was to analyze the sensitivity and specificity of symptoms, endoscopy, barium esophagography, and manometry as compared to pH monitoring in the preoperative evaluation of patients for ARS. Patients and Methods One hundred and thirty-eight patients were referred for ARS with a diagnosis of GERD based on symptoms, endoscopy, and/or barium esophagography. Barium esophagography, esophageal manometry, and ambulatory 24h pH monitoring were performed preoperatively in every patient. Results Four patients were found to have achalasia and were excluded from the analysis. Based on the presence or absence of gastroesophageal reflux on pH monitoring, the remaining 134 patients were divided into two groups: GERD+ (n078, 58 %) and GERD− (n056, 42 %). The groups were compared with respect to the incidence of symptoms, presence of reflux and hiatal hernia on esophagogram, endoscopic findings, and esophageal motility. There was no difference in the incidence of symptoms between the two groups. Within the GERD+ group, 37 patients (47 %) had reflux at the esophagogram and 41 (53 %) had no reflux. Among the GERD− patients, 17 (30 %) had reflux and 39 (70 %) had no reflux. A hiatal hernia was present in 40 and 32 % of patients, respectively. Esophagitis was found at endoscopy in 16 % of GERD+ patients and in 20 % of GERD− patients. Esophageal manometry showed no difference in the pressure of the lower esophageal sphincter or quality of peristalsis between the two groups. Conclusions The results of this study showed that (a) symptoms were unreliable in diagnosing GERD, (b) the presence of reflux or hiatal hernia on esophagogram did not correlate with reflux on pH monitoring, (c) esophagitis on endoscopy had low sensitivity and specificity, and (d) manometry was mostly useful for positioning the pH probe and rule out achalasia. Ambulatory 24-h pH monitoring should be routinely performed in the preoperative work-up of patients suspected of having GERD in order to avoid unnecessary ARS.
Outcomes After Esophagectomy in Patients With Prior Antireflux or Hiatal Hernia Surgery
The Annals of Thoracic Surgery, 2010
Background-Esophagectomy is indicated occasionally for the treatment of patients with refractory gastroesophageal reflux disease (GERD) or recurrent hiatus hernia. The purpose of this study was to evaluate the impact of previous gastroesophageal operations on outcomes after esophagectomy for recurrent GERD or hiatus hernia.
Isolated upright gastroesophageal reflux is not a contraindication for antireflux surgery
Surgery, 1997
Background. Patients with gastroesophageal rejlux disease who rejlux only in the ,upright position are thought to have a less severe abnormality. Controvers) exists over whether these patients should be considered candidates for antireflux surgery Methods. A total of 224 consecutive patients with increased esophageal acid exposztre on 24-hour PH monitoring were classified as having upright (n = 54), supine (n = 72), or bzpositional (n = 98) rejlux and were evaluated by manometrJ and endoscopy Of these, 116 patients had a laparoscopic Nissen fundoplication. Their clinical outcome at a median of 12 months (range 4 to 44 mon.ths) was compared. Results. Patients with upright reflux had a lower prevalence of a structuralQ defective lower esophageal sphilzcter; fewer hiatal hernia,s, and less esophageal injury when compared to those with bipositional reJux (p < 0.005). Excellent (asymptomaticj or good outcome (minor symptoms not requiring acid suppression therapy) was achieved in 86% of the patien ts with upright rejlux, 90% of those with sup&e rejlux, avzd 89% of those with bipositiorzal rejlux. Conclusions. Patients with upright rejlux have less complicated, earlier disease and have results equivalent to those patients with supine and bipositional reflux after antirejlux su'rgery (Surgery 1997;122:829-35.
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.
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.
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...
Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease in England
Annals of Surgery, 2018
Background: After antireflux surgery, highly variable rates of recurrent gastroesophageal reflux disease (GERD) have been reported. Objective: To identify the occurrence and risk factors of recurrent GERD requiring surgical reintervention or medication. Methods: The Hospital Episode Statistics database was used to identify adults in England receiving primary antireflux surgery for GERD in 2000 to 2012 with follow-up through 2014, and the outcome was surgical reintervention. In a subset of participants, the Clinical Practice Research Datalink was additionally used to assess proton pump inhibitor therapy for at least 6 months (medical reintervention). Risk factors were assessed using multivariable Cox regression providing adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). Results: Among 22,377 patients who underwent primary antireflux surgery in the Hospital Episode Statistics dataset, 811 (3.6%) had surgical reintervention, with risk factors being age 41 to 60 years (HR ¼ 1.22, 95% CI 1.03-1.44), female sex (HR ¼ 1.5; 95% CI 1.3-1.74), white ethnicity (HR ¼ 1.71, 95% CI 1.06-2.77), and low hospital annual volume of antireflux surgery (HR ¼ 1.32, 95% CI 1.04-1.67). Among 2005 patients who underwent primary antireflux surgery in the Clinical Practice Research Datalink dataset, 189 (9.4%) had surgical reintervention and 1192 (59.5%) used proton pump inhibitor therapy, with risk factors for the combined outcome being age >60 years (HR ¼ 2.38, 95% CI 1.81-3.13) and preoperative psychiatric morbidity (HR ¼ 1.58, 95% CI 1.25-1.99). Conclusion: At least 3.6% of patients may require surgical reintervention and 59.5% medical therapy following antireflux surgery in England. The influence of patient characteristics and hospital volume highlights the need for patient selection and surgical experience in successful antireflux surgery.
Journal of the Formosan Medical Association = Taiwan yi zhi, 2002
Laparoscopic antireflux surgery has recently been introduced as an alternative to laparotomy for the treatment of gastroesophageal reflux disease (GERD) at National Taiwan University Hospital. This study compared the results of traditional open and laparoscopic fundoplication for the treatment of GERD. The surgical records and medical charts of 29 adult patients who were surgically treated for GERD between 1980 and 2001 were retrospectively reviewed. The clinical characteristics, indications for surgery, and surgical findings and procedures were analyzed. Laparotomy and Nissen fundoplication were carried out on 20 of the patients between 1985 and 2000. Laparoscopic Nissen or Toupet fundoplication was performed on nine patients between 1997 and 2001. Patients in the laparoscopic group were younger than those in the laparotomy group (46.7 +/- 15.9 vs 58.3 +/- 18.5 yr). The incidence of associated prominent hiatal hernia was significantly higher in the laparotomy group (60 vs 33%). The...