Efficacy and Safety of Dor Fundoplication in Patients with Severe Gastroparesis and Refractory Gastroesophageal Reflux Disease

Asaad Ishak,Richard W Mccallum,Irene Sarosiek,Brian Davis,Ihsan Al-Bayati

doi:10.3390/gidisord2020013

Abstract

Poor quality of life is a major problem in patients with gastroesophageal reflux disease (GERD). Delayed gastric emptying in patients with severe gastroparesis (GP) worsens GERD symptoms and particularly nocturnal heartburn and regurgitation refractory to medical therapy. With limited therapeutic options, a Nissen fundoplication may be considered but concerns for this surgery are inability to wretch and vomit post-op, increasing the risk of wrap rupture. Dor fundoplication, a 180–200 degree anterior wrap, may improve sphincter competency and provide symptom relieve while minimizing these concerns and avoiding vagal nerve damage.

Highlights

Gastroesophageal reflux disease (GERD) is characterized by heart burn and regurgitation resulting from gastric acid and non-acid contents flowing back through an incompetent lower esophageal sphincter causing mucosal irritation
Six patients (83.3% females), mean age of 49.9 (33–65) with gastroparesis documented by a 4-h scintigraphic study, one of diabetic etiology and five regarded as idiopathic in etiology underwent simultaneous GES, PP and Dor fundoplication (DF) for drug refractory GP and GERD, from October 2015 to August 2018
We demonstrated that Dor fundoplication can be performed safely in patients with refractory GERD in the setting of severe GP

Summary

Introduction

Gastroesophageal reflux disease (GERD) is characterized by heart burn and regurgitation resulting from gastric acid and non-acid contents flowing back through an incompetent lower esophageal sphincter causing mucosal irritation. Surgical approaches to manage refractory gastroparesis include gastric electrical stimulation, pyloroplasty and total gastrectomy [5,6]. The theory behind the Dor partial fundoplication concept is that GP patients may need to vomit or retch from time to time; it is not possible with the standard Nissen fundoplication and it may even lead to rupture of the wrap. The Dor partial fundoplication will minimize gas-bloat syndrome, a very common complication of standard fundoplication because burping and belching is difficult. We sought to study the safety and efficacy of a laparoscopic surgical approach to perform a (Dor fundoplication (DF), Pyloroplasty (PP) and gastric electrical stimulation (GES) placement) for the combination of refractory GERD and severe GP

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Discussion

Conclusion