Abstract
As the incidence of gastroesophageal reflux disease (GERD) is rising, surgical treatment is continuously advancing in an effort to minimize side effects, whilst maintaining efficacy. From a database of patients that underwent anti-reflux surgery at our institution between 2015 and 2018, the last 25 consecutive patients that underwent electrical stimulation (ES), magnetic sphincter augmentation (MSA) and Nissen fundoplication (NF), following a personalized treatment decision aid, were included in a comparative analysis. After preoperative evaluation each patient was referred for an ES, MSA or NF based on esophageal motility, hiatal hernia (HH) size and the patients’ preferences. Postoperative gastrointestinal symptoms and GERD-Health-related-Quality-of-Life were assessed. Preoperatively the median DCI (299 ES vs. 1523.5 MSA vs. 1132 NF, p = 0.001), HH size (0.5 cm ES vs. 1 cm MSA vs. 2 cm NF, p = 0.001) and presence of GERD-related symptoms differed significantly between the groups. The highest rate of postoperative dysphagia was seen after MSA (24%, p = 0.04), while the median GERD HRQL total score was equally distributed between the groups. The positive short-term postoperative outcome and patient satisfaction indicate that such an aid in treatment indication, based on esophageal motility, HH size and patient preference, represents a feasible tool for an ideal choice of operation and an individualized therapy approach.
Highlights
Gastroesophageal reflux disease (GERD) is a public health issue, affecting up to 33% of the population worldwide, spanning across all age groups and both sexes[1,2]
A hiatal hernia was present in sixty-six of the patients, two from which were type III hernias using the classification of Hill et al.[33]
When further comparing the median total pH < 4%, total number of reflux episodes, lower esophageal sphincter end expiratory (LES EE) pressure and integrated relaxation pressure (IRP), we found no difference between the groups
Summary
Gastroesophageal reflux disease (GERD) is a public health issue, affecting up to 33% of the population worldwide, spanning across all age groups and both sexes[1,2]. 40% of GERD patients remain symptomatic under medical treatment and proton pump inhibitors have been associated with various long-term adverse effects, rates of anti-reflux surgery have significantly decreased since achieving a peak in 20093–8. The laparoscopic 360-degree fundoplication has been tailored to a 270-degree fundoplication (Toupet) as well as an anterior 120-degree fundoplication (Dor)[11,12] Both modifications have been reported with lower dysphagia rates NF remains superior in long-term reflux cessation and symptom relief[3,12,13,14,15]. Aim of this study was to analyze the short-term postoperative symptom control, adverse effects, and patient satisfaction in patients undergone laparoscopic ES, MSA and NF respectively, according to an established treatment decision aid and subsequently the safety and feasibility of such in a high output specialized reflux center
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
