Serotonin blood level study, anxiety-depressive states indicators and patients life quality after laparoscopic treatment of gastroesophageal reflux disease

Part 1 GERD - mechanisms and diagnosis: pathogenesis a possible role for helicobacter pylori in the pathogenesis of reflux oesophagus epidemiology clinical symptoms and prognosis endoscopic classification of reflux oesophagitis by the MUSE system diagnosis. Part 2 State of the art - lecture: solving the GORDian knot, I.M. Modlin et al. Part 3 GERD - nonoperative treatment: inhibition of acid secretion treatment of motility disorders interventional endoscopic therapy. Part 4 GERD and Barrett's oesophagus: the prognosis of Barrett's oesophagus and its relationship with GERD endoscopic surveillance of Barrett's oesophagus is there regression in Barrett's oesophagus?. Part 5 Surgical treatment of GERD: Nissen fundoplication - the gold standard long-term outcome after open fundoplication complications and late consequences of open fundoplication for GERD laparoscopic fundoplication - history of a trend-setting operation laparoscopic antireflux surgery - principles governing assessment of patients for endoscopic surgery and options for surgical treatment failure and pitfalls of Nissen repair. Part 6 International results of laparoscopic fundoplication: German experience with laparoscopic antireflux surgery laparoscopic Nissen fundoplication in the USA early results in the Swiss experience with laparoscopic fundoplication for GERD laparoscopic antireflux surgery in the United Kingdom and Ireland laparoscopic floppy Nissen fundoplication - the Groote Schuur hospital experience. Part 7 Safe performance of a laparoscopic fundoplication: laparoscopic treatment of gastro-oesophageal reflux - Nissen-Rosseti fundoplication safe performance of a laparoscopic Nissen fundoplication - standard technique II the technique of Nissen fundoplication laparoscopic Toupet partial fundoplication laparoscopic anterior partial fundoplication laparoscopic treatment of paraoesophageal hernia laparoscopic cardiomyotomy for achalasia. Part 8 Conclusion: gastro-oesophageal reflux disease (GERD) - back to surgery?, M.W. Buchler et al.

Gastroesophageal Reflux Disease (GERD) is an extremely common condition with several medical and surgical treatment options. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians, patients, and others in decisions regarding the treatment of GERD with an emphasis on evaluating different surgical techniques. Literature reviews were conducted for 4 key questions regarding the surgical treatment of GERD in both adults and children: surgical vs. medical treatment, robotic vs. laparoscopic fundoplication, partial vs. complete fundoplication, and division vs. preservation of short gastric vessels in adults or maximal versus minimal dissection in pediatric patients. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Recommendations for future research were also proposed. The panel provided seven recommendations for adults and children with GERD. All recommendations were conditional due to very low, low, or moderate certainty of evidence. The panel conditionally recommended surgical treatment over medical management for adults with chronic or chronic refractory GERD. There was insufficient evidence for the panel to make a recommendation regarding surgical versus medical treatment in children. The panel suggested that once the decision to pursue surgical therapy is made, adults and children with GERD may be treated with either a robotic or a laparoscopic approach, and either partial or complete fundoplication based on surgeon-patient shared decision-making and patient values. In adults, the panel suggested either division or non-division of the short gastric vessels is appropriate, and that children should undergo minimal dissection during fundoplication. These recommendations should provide guidance with regard to surgical decision-making in the treatment of GERD and highlight the importance of shared decision-making and patient values to optimize patient outcomes. Pursuing the identified research needs may improve future versions of guidelines for the treatment of GERD.

Getting into a TIF(F) Over Fundoplication

The fundoplication conventionally given in open surgery in the surgical treatment of gastroesophageal reflux disease (GERD) are reproducible with laparoscopic way. The aim of this study was to evaluate our results of surgical treatment of GERD refractory to medical treatment performed laparoscopically. Between 2005 and 2008, 30 patients underwent fundoplication in this way. The diagnosis of GERD was suspected clinically and confirmed in spite of lack of esophageal manometry and pH-metry by the barium esophagogram and endoscopy. Three fundoplication techniques were used in the series: Nissen-Rossetti, Toupet and Nissen. The postoperative course was uneventful with a carrying on of oral feeding on postoperative day 3, an average hospital stay of five days and low transient dysphagia. Laparoscopic fundoplication is currently the consensual surgical treatment of GERD. The debate on the type of fundoplication is not closed but the introduction of laparoscopy in our practice has improved the acceptability of surgery especially in younger patients in good health frequent relapses.

Our aim was to estimate the efficacy of laparoscopic and open Nissen fundoplication (ONF) in the treatment of gastroesophageal reflux disease (GERD) in children. An electronic systematic review of the published literature was conducted in Cochrane Library, MEDLINE (PubMed), and EmBase in October 2015 in English and without time restrictions. The participants, interventions, and comparisons in the clinical question translated directly into eligibility criteria for study inclusion and exclusion. Study information extraction and methodological quality assessments were accomplished by two reviewers independently. Methodological quality was assessed by using the "Criteria for judging risk of bias in the 'Risk of bias' assessment tool." Odds ratio (OR) with 95 per cent confidence interval was computed as summary statistics. Fixed-effects model was used and a pooled OR was calculated with the Mantel-Haenszel method initially. If the studies were heterogeneous, then the DerSimonian and Laird random effects model was used for meta-analysis. Outcome indices included mortality of patients, recurrence of GERD, reoperation of GERD, patients with complications, length of postoperative hospital stay, and surgery duration of laparoscopic Nissen fundoplication (LNF) and ONF. Statistical analyses were carried out by using Review Manager 5.2. The duration of follow-up varied between two days and four years. Children operated with LNF had a higher recurrence rate of GERD than those undergoing ONF. The pooled OR of LNF versus ONF was 2.98 (95% confidence interval = 1.29-6.87) while the heterogeneity was I2 = 47 per cent and P = 0.13. Statistical analysis showed that there was no significant difference for mortality, reoperation, and complication. The mean duration of surgery was significantly longer in the LNF than the ONF group while the results of length of postoperative hospital stay remained inconformity. In this meta-analysis, children operated with LNF had a higher recurrence rate of GERD than those undergoing ONF. Meanwhile, when considering the outcomes of mortality, reoperation, and complications, there was no significant difference. The mean duration of surgery was significantly longer in the LNF than the ONF group while no consistent conclusion of length of postoperative hospital stay was found.

To analyze long-term outcome of a randomized clinical trial comparing laparoscopic Nissen fundoplication (LNF) and conventional Nissen fundoplication (CNF) for the treatment of gastroesophageal reflux disease (GERD). LNF has replaced CNF, based on positive short and mid-term outcome. Studies with a follow-up of over 15 years are scarce, but are desperately needed for patient counselling. Between 1997 and 1999, 177 patients with proton pump inhibitor (PPI)-refractory GERD were randomized to CNF or LNF. Data regarding the presence of reflux symptoms, dysphagia, general health, PPI use, and need for surgical reintervention at 17 years are reported. A total of 111 patients (60 LNF, 51 CNF) were included. Seventeen years after LNF and CNF, 90% and 95% of the patients reported symptom relief, with no differences in GERD symptoms or dysphagia. Forty-three and 49% of the patients used PPIs (NS). Both groups demonstrated significant improvement in general health (77% vs 71%; NS) and quality of life (75.3 vs 74.7; NS). Surgical reinterventions were more frequent after CNF (18% vs 45%; P = 0.002), mainly due to incisional hernia corrections (3% vs 14%; P = 0.047). The effects of LNF and CNF on symptomatic outcome and general state of health remain for up to 17 years after surgery, with no differences between the 2 procedures. CNF carries a higher risk of surgical reintervention, mainly due to incisional hernia corrections. Patients should be informed that 17 years after Nissen fundoplication, 60% of the patients are off PPIs, and 16% require reoperation for recurrent GERD and/or dysphagia.

Laparoscopic magnetic sphincter augmentation (MSA) with the LINX device is a promising new therapy for the treatment of gastroesophageal reflux disease (GERD). Initial studies have demonstrated MSA to be safe and effective. However, no direct comparison between MSA and laparoscopic Nissen fundoplication (LNF), the gold standard surgical therapy for GERD, has been performed. A single institution, case-control study was conducted of MSA performed from 2012 to 2013 and a cohort of LNF matched for age, gender, and hiatal hernia size. MSA and LNF were both effective treatments for reflux with 75 and 83 % of patients, respectively, reporting resolution of GERD at short-term follow-up. Dysphagia was common following both MSA and LNF, but severe dysphagia requiring endoscopic dilation was more frequent after MSA (50 vs. 0 %, p = 0.01). Need for dilation did not correlate with size of the LINX device or any other examined patient factors. A trend toward decreased adverse GI symptoms of bloating, flatulence, and diarrhea was seen after MSA compared to LNF (0 vs. 33 %). MSA had a shorter operative time (64 vs. 90 min, p < 0.01) but other peri-operative outcomes, including pain, morbidity, and re-admissions were equivalent to LNF. MSA patients were more likely to be self-referred (58 vs. 0 %, p < 0.001). MSA and LNF are both effective and safe treatments for GERD; however, severe dysphagia requiring endoscopic intervention is more common with MSA. Other adverse GI side effects may be less frequent after MSA. Consideration should be paid to these distinct post-operative symptom profiles when selecting a surgical therapy for reflux disease.

Objective To evaluate laparoscopic Nissen fundoplication for the treatment of gastroesophageal reflux disease related obstructive sleep apnea syndrome. Methods 18 patients of obstructive sleep apnea syndrome received laparoscopic Nissen fundoplication for gastroesophageal reflux disease, and were requested to fill two questionnaires including Reflux Diagnostic Questionnaire and Epworth Sleepiness Scale. The diagnosis of obstructive sleep apnea syndrome had been established by polysomnography. Results At 1 year after the operation, the total score decreased from 18(8-40) preoperativly to 0(0-3) postoperativly(z=3.730, P<0.05), with each total score<12. The Epworth Sleepiness Scale score decreased from 13±5 to 7±3 (t=7.834, P<0.05). The DeMeester integral decreased from 39±34 to 10±7 (t=4.394, P<0.05). The sleep apnea hypoventilation index decreased from 33±18 (time/h) to 7±8 (time/h)(t=5.762, P<0.05), the lowest SpO2 increased from 73%±13% to 88%±4% (t=5.401, P<0.05), and the time of SpO2<90% decreased from 252±130 (time) to 57±59 (time) (t=6.176, P<0.05). Conclusion Laparoscopic Nissen fundoplication is a safe and effective treatment for obstructive sleep apnea hypopnea syndrome. Key words: Gastroesophageal reflux; Sleep apnea, obstructive; Fundoplication

Aim: To present and evaluate our surgical technique for laparoscopic total fundoplication with myotonic crural component (LTFMCC).Patients and Methods: This study included 72 patients with a confirmed diagnosis of gastroesophageal reflux disease (GERD) who underwent fundoplication and agreed to the new technique of laparoscopic fundoplication using LTFMCC. Patients were randomly divided into two groups. The first group (A, n = 30) underwent LTFMCC. After standard steps, our operative technique involved cruroraphy and fundoplication with suturing of the right and left diaphragmatic crura below the esophagus using two interrupted nonabsorbable 2-O stitches placed in the middle of the crura length. The hiatal orifice was divided into two parts: an upper window fixed to the esophagus and a lower window with left and right crura fixation to the anterior and posterior parts of the stomach fundus, respectively. There were no sutures between the posterior and anterior parts of the fundus, but this novel procedure creates a 360° fundoplication with a myotonic component. The second group of patients (B, n = 42) underwent standard laparoscopic Nissen total fundoplication (LTFN). The average age of patients was 45.9 ± 13.0 years in group A and 47.0 ± 11.1 years in group B (t = -0.38, p = 0.71). In group A, there were 20 men and 10 women whereas group B had 24 men and 18 women. Results: All LTFMCC procedures were successfully completed laparoscopically. Operation complexity and time of LTFMCC did not differ significantly from the standard laparoscopic Nissen fundoplication. The myotonic component relieves suture tension and provides tone for the fundoplication wrap. There were no serious intraor postoperative complications or side effects. Mean postoperative hospital stay was 3 days.Conclusions: In our experience LTFMCC is a safe and effective procedure in the treatment of GERD.

Issue Highlights

Laparoscopic antireflux surgery is an established method of treatment of gastroesophageal reflux disease (GERD). This study evaluates the efficacy of Nissen versus Toupet fundoplication in alleviating the symptoms of GERD and compares the two techniques for the development of post-fundoplication symptoms and quality of life (QOL) at 12 months post-surgery. In this prospective consecutive cohort study, 94 patients presenting for laparoscopic antireflux surgery underwent either laparoscopic Nissen fundoplication (LN) (n = 51) from February 2002 to February 2004 or a laparoscopic Toupet fundoplication (LT) (n = 43) from March 2004 to March 2006, performed by a single surgeon (G. S. S.). Symptom assessment, a QOL scoring instrument, and dysphagia questionnaires were applied pre- and postoperatively. At 12 months post-surgery, patient satisfaction levels in both groups were high and similar (LT: 98%, LN: 90%; P = 0.21). The proportion of patients reporting improvement in their reflux symptoms was similar in both groups (LT: 95%, LN: 92%; P = 0.68), as were post-fundoplication symptoms (LT: 30%, LN: 37%; P = 0.52). Six patients in the Nissen group required dilatation for dysphagia compared with one in the Toupet group (LT: 2%, LN: 12%; P = 0.12). One patient in the Nissen group required conversion to Toupet for persistent dysphagia (P = 0.54). In this series, overall symptom improvement, QOL, and patient satisfaction were equivalent 12 months following laparoscopic Nissen or Toupet fundoplication. There was no difference in post-fundoplication symptoms between the two groups, although there was a trend toward a higher dilatation requirement and reoperation after Nissen fundoplication.

Surgical therapy for gastroesophageal reflux disease (GERD) is controversial with considerable debate ranging from the indications for antireflux surgery to surgical technique. This article will attempt to clarify these issues with the most up-to-date information available on the prevalence, pathophysiology, diagnosis, and surgical treatment of GERD in children. Although laparoscopic Nissen fundoplication (LNF) has become the most popular operation performed for pathologic reflux, its superiority over both open surgery and other types of fundoplication is not well established. Large retrospective studies suggest LNF has a lower complication rate than open surgery. However, three prospective randomized controlled trials have been published recently which cast doubt on the superiority of LNF and suggest that LNF may have a higher failure rate compared to open fundoplication. Antireflux surgery has higher morbidity and failure rates in infants and in children with neurologic impairment. Based on the best available evidence, LNF may be less morbid, but have a higher rate of failure than open surgery. Pediatric surgeons should be mindful of the risks and benefits of both approaches to best counsel their patients. Larger prospective randomized controlled trials are needed to determine the best treatments for pediatric GERD.

Persistent Dysphagia Rate After Antireflux Surgery is Similar for Nissen Fundoplication and Partial Fundoplication

Association between persistent symptoms and long-term quality of life after laparoscopic total fundoplication

Although anti-reflux surgery has been used liberally over the past decades for the treatment of gastroesophageal reflux disease (GERD), few studies report follow-up after 10 years. This study was undertaken to report follow-up on 100 consecutive GERD patients up to 22 years after utilizing a laparoscopic fundoplication. Hundred consecutive patients undergoing laparoscopic fundoplication for GERD were prospectively followed beginning in 1992. The frequency and severity of symptoms before and after laparoscopic fundoplication were scored on a Likert scale (1 = never/none to 10 = always/very bothersome). Median data are reported. Of the 100 patients who underwent laparoscopic fundoplication for their GERD, nine were reoperations. Twenty-six patients are deceased on average 11 years after their fundoplications. Seventy-four patients are alive, with 27 patients, actively followed for 19 years after their fundoplications. At most recent follow-up, patients experienced long-term amelioration of symptom frequency and severity after fundoplication (e.g., heartburn frequency = 8-2, severity = 8-1; P < 0.01 for each). Eighty-four per cent of patients rated their symptom frequency as less than once per month. Eighty-eight per cent of patients were satisfied with their postoperative results, and 95 per cent of patients confirmed they would have the operation again knowing what they know now. Long-term follow-up documents high patient satisfaction and durable symptomatic relief up to two decades after laparoscopic fundoplication for GERD. Patients should seek this operation not only for symptomatic relief, but to mitigate the deleterious effects of long-term acid exposure and anti-acid therapy.