Laparoscopic anti-reflux surgery to treat proton pump inhibitor-resistant non-erosive reflux disease

Abstract

We performed surgery for proton pump inhibitor-resistant non-erosive reflux disease patients whose symptom index, confirmed by combined multichannel intraluminal impedance–pH monitoring, was positive. Laparoscopic Nissen fundoplication was performed in five patients and laparoscopic Toupet fundoplication in 3 patients. In 6 of 8 patients, non-acid or minor acid reflux caused the symptoms. Satisfaction percentages assessed 1 year postoperatively were 12.5 % (excellent) and 87.5 % (good).The number of total reflux events decreased to 28.5 ± 14.4 % postoperatively. The symptom index decreased from 63.8 to 20.8 %. It is controversial whether the surgery reduces weakly acidic reflux to the same degree as acid reflux. Previous reports discuss the effect of laparoscopic Nissen fundoplication on acid and weakly acidic reflux; however, the results of these studies are contradictory. In our cases, laparoscopic Toupet fundoplication as well as Nissen fundoplication improved symptoms, and reduced acid and non-acid reflux similarly. These findings strongly support the importance of surgical intervention in proton pump inhibitor-resistant non-erosive reflux disease patients.