PS01.053: GASTRO-ESOPHAGEAL REFLUX TEST DECIDING SURGICAL INDICATION AND RESULTS OF LAPAROSCOPIC NISSEN FUNDOPLICATION FOR GERD PATIENTS

Abstract

Abstract Background The indication of laparoscopic anti-reflux surgery for GERD patients is difficult to be judged fairly. We have established ‘Reflux Test‘ as the tool for the decision in the surgical indication for GERD patients. Methods Reflux Test At the standing position a patient swallows 300 ml barium solution. After total solution goes into stomach, a patient lies down at the flat position. Then a patient changes the position to left lateral decubitus position, flat position, right lateral decubitus position and flat position again every 10 seconds in the order. During this procedure, gastro-esophageal reflux was evaluated and assigned to severe, moderate and slight category. If the reflux was observed slightly up to cervical esophagus, the case was assigned to moderate category. If the reflux was observed intensely up to cervical esophagus, the position was returned to head high position for the safety and the case was assigned to severe category. The anti-reflux surgery was considered in the moderate and severe categories. Results We have performed laparoscopic Nissen procedure in 90 cases. The mean operation time of recent 20 cases was 90 min. The outcome was assessed by Reflux Test performed on 4–5 postoperative day, and the results showed no reflux in every cases. Median follow-up period of this study was 48 months (0–99 months). In 11 cases (12.6%) PPI was restarted before 6 months after the anti-reflux surgery. In 23 cases (25.6%) PPI was restarted after the anti-reflux surgery during the whole follow-up period of this study. The BMI of the patients had no relationship to the needed PPI restart. To evaluate the degree of esophagitis objectively before and after the anti-reflux surgery we designed ‘the esophagitis score’. In this scoring method, a number from 0–5 was assigned according to the degree of esophagitis along with the LA classification. The results of the study have shown that the reflux esophagitis was improved obviously after the anti-reflux surgery even in the PPI restarted group (P < 0.001). Conclusion Reflux Test is feasible because of its convenience and visual effects for the patients. The results of the laparoscopic Nissen fundoplication were good and satisfied by the patients mostly. Disclosure All authors have declared no conflicts of interest.