Effect Of Laparoscopic Fundoplication Research Articles

Effect of laparoscopic fundoplication on esophageal motility in patients with gastroesophageal reflux disease

The article presents the results of a prospective observational study on the effect of laparoscopic fundoplication on esophageal motility in patients with gastroesophageal reflux disease associated with hiatal hernia. It has been found that in this category of patients, the antireflux intervention significantly leads to an improvement in manometric parameters. This result is primarily due to the restoration of esophageal motility with its preoperative inefficiency in patients with type III hernias. Regarding segmental distal esophageal spasm, the fundoplication demonstrates a multidirectional effect. Surgical treatment may not affect this type of dysmotility in any way, may lead to the motility normalization, or cause the development of a similar variant of hyperkinesis in the postoperative period. When deciding whether to perform laparoscopic fundoplication, the presence of ineffective esophageal motility or distal esophageal spasm in patients is not an absolute contraindication for surgical intervention.

Therapeutic effect of laparoscopic fundoplication for GERD-related disease in the elderly.

It is anticipated that surgical treatment for gastro-esophageal reflux disease (GERD) in the elderly will increase. This time, using propensity score matching, we examined the results of laparoscopic fundoplication (LF) for GERD-related diseases in the elderly. Of 302 cases which underwent initial LF for GERD-related diseases during the period from June 2008 to February 2019, we classified them into elderly (65years of age or older) and non-elderly groups (64years of age or younger). 57 cases each were extracted upon performing propensity score matching regarding five factors including: gender; body mass index; esophageal hiatal hernia; extent of reflux esophagitis; and the use of mesh. With regard to the preoperative disease status, the pH < 4 holding time was indicated as 2.8% (0.5-10.7%) in the elderly group and 3.4% (0.6-8.0%) in the non-elderly group, with no difference in terms of the illness period as well (p = 0.889 and p = 0.263, respectively). Although there was no difference in terms of the operative time (155 vs. 139min, p = 0.092) and estimated blood loss (both≒0ml, p = 0.298), postoperative hospital stay was prolonged in the elderly group [7 (7-9) vs. 7 (7-7), p = 0.007]. On the other hand, esophageal hiatal hernia, reflux esophagitis, and acid reflux time in the esophagus were all improved following surgery in both groups (p < 0.001 in both groups). The treatment results of LF for GERD-related diseases in the elderly were as good as those in the non-elderly, indicating possible safe implementation.

Does weight gain, throughout 15 years follow-up after Nissen laparoscopic fundoplication, compromise reflux symptoms control?

ABSTRACT Background: Gastroesophageal reflux disease is defined by the abnormal presence of gastric content in the esophagus, with 10% incidence in the Western population, being fundoplication one treatment option. Aim: To evaluate the early (six months) and late (15 years) effectiveness of laparoscopic fundoplication, the long term postoperative weight changes, as well as the impact of weight gain in symptoms control. Methods: Prospective study of 40 subjects who underwent laparoscopic Nissen’s fundoplication. Preoperatively and early postoperatively, clinical, endoscopic, radiologic, manometric and pHmetric evaluations were carried out. After 15 years, clinical and endoscopic assessments were carried out and the results compared with the early ones. The presence or absence of obesity was stratified in both early and late phases, and its influence in the long-term results of fundoplication was studied, measuring quality of life according to the Visick criteria. Results: The mean preoperative ages, weight, and body mass index were respectively, 51 years, 69.67 kg and 25.68 kg/m2. The intraoperative and postoperative complications rates were 12.5% and 15%, without mortality. In the early postoperative period the symptoms were well controlled, hernias and esophagitis disappeared, the lower esophageal sphincter had functional improvement, and pHmetry parameters normalized. In the late follow-up 29 subjects were assessed. During this period there was adequate clinical control of reflux regardless of weight gain. In both time periods Visick criteria improved. Conclusion: Fundoplication was safe and effective in early and late periods. There was late weight gain, which did not influence effective symptoms control.

Typical symptoms and not positive reflux-cough correlation predict cure of gastroesophageal reflux disease related chronic cough after laparoscopic fundoplication: a retrospective study

BackgroundThe effect of laparoscopic fundoplication on reflux-related chronic cough is unpredictable, the aim of the study is to investigate the predictive effect of positive reflux-cough correlation on the resolution of reflux-related chronic cough after anti-reflux surgery.MethodsA 5 years retrospective review was performed. Logistic regression analysis was used to determine the independent predictors on the cure of chronic cough.ResultsSeventy-nine patients were included in this study, among which chronic cough was cured in 47 (59.5%) and significantly improved in 10 (12.7%) patients. Present of typical symptoms (odds ratio = 6.435,95% confidence interval [CI] = 1.427–29.032, p = 0.015) and number of Reflux episodes (impedance) ≥73 (odds ratio = 0.306, 95% confidence interval [CI] = 0.107–0.874, p = 0.027) were significantly associated with the cure of chronic cough.Conclusionslaparoscopic fundoplicaiton is effective for the management of reflux-related chronic cough, particularly with the present of typical symptoms.Trial registration(Trial registration number: ChiCTR1800016444; Trial registration date: June 01, 2018)

The effect of laparoscopic fundoplication in therapy of Barrett's esophagus.

IntroductionBarrett's esophagus is the most significant precancer of the esophagus. Its malignization gives rise to most adenocarcinomas of the esophagus. Therefore selection of adequate therapy for this precancerous condition is of the utmost importance.AimThe authors of the work addressed the question of whether effective therapy of reflux disease alone may halt the process of malignization of Barrett's mucosa or even cause its regression.Material and methodsThe analyzed set comprised 50 patients with Barrett's esophagus, who in 48 cases underwent laparoscopic fundoplication and in two cases underwent an indirect antireflux procedure in the form of gastric resection with a Roux-en-Y gastrojejunal anastomosis. The effect of the procedure was evaluated by comparing preoperative and postoperative endoscopic examinations, as well as histological analysis by biopsy taken from Barrett's mucosa.ResultsIn 19 patients (38%), Barrett's mucosa was not detected postoperatively. An improved finding in terms of disappearance of mucosal dysplasia was found in 8 (16%) patients. Findings remained unchanged in 18 (36%) patients. In 5 (10%) patients progression of the disease was discovered.ConclusionsA surgical antireflux procedure, primarily in the form of laparoscopic fundoplication, is considered an effective method for treating Barrett's esophagus up to the stage of mild dysplasia. If this therapy is unsuccessful, the method of choice is local therapy, either an endoscopic mucosectomy or radiofrequency ablation.

Effect of Laparoscopic Fundoplication on Hypertensive Lower Esophageal Sphincter Associated with Gastroesophageal Reflux

For hypertensive lower esophageal sphincter with dysphagia and chest pain, a laparoscopic cardiomyotomy is recommended. Recently, the role of gastroesophageal reflux in this abnormality has been recognized. A prospective study on six patients with manometrically proven hypertensive lower esophageal sphincter was performed. Laparoscopic floppy Nissen fundoplication was performed in all cases. The first follow up was performed 6 weeks after the operation. The mean follow up time was 56 months (range 50–61). Before the operation, all patients had abnormal esophageal acid exposure. Mean DeMeester score was 41.7 (range 16.7–86). Average LES pressure before the operation was 50.5 mmHg (range 35.6–81.3). Six weeks after operation, all patients were symptom free. DeMeester score returned to a normal level of 2.9. Furthermore, a marked decrease in the lower esophageal sphincter pressure (24.7 mmHg) was detected. At late follow up, all patients were symptom-free, and only two patients agreed to undergo functional testing. The mean DeMeester score of this two patients was 1.2. The pressure remained at normal value (15.7 mmHg). In our study, an antireflux operation normalized lower esophageal sphincter pressure suggesting that abnormal esophageal acid exposure may be an etiologic factor in the development of hypertensive lower esophageal sphincter.

Efficacy of laparoscopic fundoplication in controlling pulmonary symptoms associated with gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD)-induced pulmonary symptoms (PS) can be difficult to control. The effectiveness of laparoscopic fundoplication (LF) in controlling PS among patients with medically recalcitrant GERD is poorly documented. We evaluated our results in controlling important PS in patients with GERD undergoing LF. Seventy-four patients (28 men, 46 women) were identified with clinically important PS from a prospective cohort of 155 patients undergoing elective LF for recalcitrant GERD. Median age was 52.5 years (range, 29-84 years). Sixty-seven (91%) patients were taking proton pump inhibitors at the time of operation. Quality of life by using the SF36 physical (PCS) and mental (MCS) component summary scores (normal, 50) and heartburn severity by using the health-related quality of life (HRQOL) (best score, 0; worst score, 45) were measured. All 74 patients with PS survived operation, and minor morbidity occurred in 5 (7%) patients. Median hospital stay was 2 days (range, 1-6 days), and return to normal activity was seen at 2.2 weeks (range, 1-8 weeks). Median follow-up was 12 months. PS were improved significantly (P < .01) for hoarseness (62% to 17.6%), bronchospasm (60% to 9.5%), and aspiration (22% to 1.4%). Before LF, 11 (14.9%) patients required bronchodilators or oral steroids. Postoperatively such therapy was required in only 3 (4.2%) patients (P = .019), with no patient requiring oral steroids. Patients with poorer control of their GERD on the basis of high HRQOL scores had significantly more PS after operation. A significant number of patients with medically recalcitrant GERD (46% from our prospective database) have important PS. LF can improve PS, decrease requirement for pulmonary medications, as well as improve typical reflux symptoms and quality of life.

Laparoscopic fundoplication for gastroesophageal reflux: effects on esophageal motility.

Laparoscopic Nissen-Rossetti fundoplication is now recognized as a valid therapy for the treatment of gastroesophageal reflux disease. This retrospective study evaluates the effects of laparoscopic fundoplication on esophageal motility and correlates these effects to postsurgical symptoms. A total of 123 patients underwent laparoscopic fundoplication at our institution. Pre- and postoperative esophageal manometric data were analyzed with regard to the effect of surgery and postsurgical outcome. Postoperative lower esophageal sphincter pressure was significantly increased compared wtih preoperative values (1.7 +/- 0.8 kPa vs 0.9 +/- 0.7 kPa). Duration and amplitude of esophageal body contractions were not modified. The percentage of deglutition-induced complete peristaltic waves and the velocity of propagation were significantly decreased after surgery (P < 0.05). Postoperative symptoms were significantly correlated with postoperative lower esophageal sphincter pressure only. Laparoscopic fundoplication significantly increases lower esophageal sphincter pressure. It significantly decreases esophageal body peristaltic efficiency, a decrease that is most likely of minor clinical significance.

Effect of laparoscopic fundoplication on gastroesophageal reflux disease-induced respiratory symptoms

Laparoscopic fundoplication controls heartburn and regurgitation, but the effects on the respiratory symptoms of gastroesophageal reflux disease (GERD) are unclear. Confusion stems from difficulty preoperatively in determining whether cough or wheezing is actually caused by reflux when reflux is found on pH monitoring. To date, there is no proven way to pinpoint a cause-and-effect relationship. The goals of this study were to assess the following: (1) the value of pH monitoring in establishing a correlation between respiratory symptoms and reflux; (2) the predictive value of pH monitoring on the results of surgical treatment; and (3) the outcome of laparoscopic fundoplication on GERD-induced respiratory symptoms. Between October 1992 and October 1998, a total of 340 patients underwent laparoscopic fundoplication for GERD. From the clinical findings alone, respiratory symptoms were thought possibly to be caused by GERD in 39 patients (11%). These 39 patients had been symptomatic for an average of 134 months. They were all taking H 2-blocking agents (21%) or proton pump inhibitors (79%). Seven patients (18%) were also being treated with bronchodilators, alone (3 patients) or in combination with prednisone (4 patients). Median length of postoperative follow-up was 28 months. In 23 patients (59%) a temporal correlation was found during 24-hour pH monitoring between respiratory symptoms and episodes of reflux. Postoperatively heartburn resolved in 91% of patients, regurgitation in 90% of patients, wheezing in 64% of patients, and cough in 74% of patients. Cough resolved in 19 (83%) of 23 patients in whom a correlation between cough and reflux was found during pH monitoring, but in only 8 (57%) of 14 of patients when this correlation was absent. Cough persisted postoperatively in the two patients who did not cough during the study. These data show that pH monitoring helped to establish a correlation between respiratory symptoms and reflux, and it helped to identify the patients most likely to benefit from antireflux surgery. Following laparoscopic surgery, respiratory symptoms resolved in 83% of patients when a temporal correlation between cough and reflux was found on pH monitoring; heartburn and regurgitation resolved in 90%.

Results of laparoscopic antireflux surgery for dysphagia and gastroesophageal reflux disease

Background: Little attention has been paid to nonobstructive dysphagia (dysphagia in the absence of an esophageal stricture) in patients with gastroesophageal reflux disease (GERD). The objectives of this study were to assess (a) the incidence of nonobstructive dysphagia in patients with GERD; and (b) the effects of laparoscopic fundoplication on nonobstructive dysphagia. Methods: Esophageal manometry and pH monitoring identified 666 patients with GERD. Two hundred and eight patients (31%) without esophageal strictures complained of dysphagia in addition to heartburn and regurgitation. Forty-nine (24%) of these patients underwent laparoscopic fundoplication. Esophageal function tests were repeated postoperatively in 12 patients (25%). Main outcome measures were effects of laparoscopic fundoplication on symptoms and esophageal motor function. Results: Dysphagia resolved postoperatively in 44 patients (90%), and improved in 2 patients (4%). Postoperative esophageal manometry showed a significant increase in the length and pressure of the lower esophageal sphincter, without changes in its ability to relax in response to swallowing. Conclusions: About one third of GERD patients without strictures experienced dysphagia; and dysphagia resolved in about 90% of such patients following a laparoscopic fundoplication.