Risk factors for recurrent gastroesophageal reflux disease after Thal fundoplication

Daisuke Ishii,Hisayuki Miyagi,Masatoshi Hirasawa

doi:10.1007/s00383-021-05001-1

Daisuke Ishii, Hisayuki Miyagi + Show 1 more

Open Access

https://doi.org/10.1007/s00383-021-05001-1

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Abstract

PurposeThe recurrence rate of gastroesophageal reflux disease (GERD) after fundoplication has been reported to be 7–25%. We investigated the risk factors for recurrence of GERD after Thal fundoplication (TF) in our department with the aim of further reducing the recurrence rate of GERD.MethodsWe retrospectively analyzed 276 patients who underwent TF for GERD at our hospital between 2000 and 2019. Retrospectively considered variables were obtained from the medical records of patients. The variables included patient characteristics, GERD severity, surgery-related factors and postoperative course.ResultsThe postoperative GERD recurrence rate was 5.8%. In the univariate analysis, the presence of convulsive seizures (12/4 vs. 110/150, p = 0.046) and the absence of a tracheostomy (0/16 vs. 53/207, p = 0.048) at the time of TF were significantly associated with recurrence. In the multivariate analysis, the presence of convulsive seizures at the time of TF was the only factor significantly associated with recurrence.ConclusionThe presence of convulsive seizures and the absence of a tracheostomy at the time of TF were significantly associated with GERD recurrence after TF. Active control of seizures and consideration of surgical indications, including assessment of respiratory status, are important in preventing the recurrence of GERD after TF.

Highlights

Gastroesophageal reflux disease (GERD) has a wide spectrum of symptoms, including esophagitis; aspiration pneumonia; and asthma attacks due to apnea
The following factors were revealed to be significantly associated with recurrence: the presence of convulsive seizures and the absence of a tracheostomy at the time of Thal fundoplication (TF), and the presence of convulsive seizures
There were no correlations between recurrence risk factors and GERD severity, surgery-related factors, or postoperative course; this finding suggested that perioperative patient status is strongly associated with GERD recurrence after TF

Summary

Introduction

Gastroesophageal reflux disease (GERD) has a wide spectrum of symptoms, including esophagitis (resulting from refluxed gastric acid disturbing the esophageal mucosa); aspiration pneumonia (due to the influx of reflux into the trachea); and asthma attacks due to apnea (via the vagus reflex). An association between GERD and apparent life-threatening events such as these has been reported [1]. This association is especially common among patients with severe motor. In most cases of GERD, fundoplication is performed to improve the patient’s quality of life (QOL), not to cure the disease. The recurrence rate of GERD after fundoplication has been reported to be 3.2–45% [6,7,8]. Few studies have examined the risk factors for the recurrence of GERD after TF. We investigated the risk factors for the recurrence of GERD after TF, with the aim of further reducing the recurrence rate of GERD

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