Laparoscopic Dor Fundoplication Research Articles

Combined thoracoscopic and laparoscopic surgery for epiphrenic diverticulum with associated gastroesophageal reflux disease: a case report

BackgroundSurgery is indicated for symptomatic epiphrenic esophageal diverticula. Based on the features of a case, thoracoscopic or laparoscopic approaches may be used. Epiphrenic diverticula are often associated with esophageal motility disorders, but cases of reflux esophagitis have rarely been reported. In this report, we describe a case of an epiphrenic esophageal diverticulum with reflux esophagitis, which was successfully treated by thoracoscopic diverticulectomy and laparoscopic fundoplication.Case presentationA 69-year-old man visited the hospital with a chief complaint of eructation and hiccup. Upper gastrointestinal endoscopy revealed a diverticulum in the left wall of the esophagus, which was 37–45 cm distal to the incisors. High-resolution manometry (HRM) showed no esophageal motility disorders. Due to the large size of the diverticulum, a thoracoscopic resection of the esophageal diverticulum was performed. Additionally, the patient had reflux esophagitis due to a hiatal hernia. The anti-reflux mechanism would be more impaired during the diverticulectomy; therefore, we decided that anti-reflux surgery should be performed simultaneously. Thoracoscopic esophageal diverticulectomy and laparoscopic Dor fundoplication were performed. The patient had an uncomplicated postoperative course and was discharged on the tenth operative day. He has been symptom-free without acid secretion inhibitors for 21 months after the surgery.ConclusionsWe described a rare case of a large epiphrenic diverticulum with reflux esophagitis. A good surgical outcome was achieved by thoracoscopic resection of the diverticulum and laparoscopic Dor fundoplication.

Clinical efficacy of laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett′s esophagus

Objective To investigate the clinical efficacy of laparoscopic fundoplication for gastro-esophageal reflux disease complicated with Barrett′s esophagus. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 12 patients with gastroesophageal reflux disease complicated with Barrett′s esophagus who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between July 2012 to July 2016 were collected. Preoperative tests of patients included distal esophageal manometry and 24-hour pH monitoring, gastroscopy and upper gastroenterography. According to preoperative evaluation of patients, laparoscopic Nissen fundoplication was preferred, and laparoscopic Dor fundoplication was used for patients with discordant esophageal peristalsis function. Observation indicators: (1) surgical and postoperative recovery situations; (2) follow-up: ① subjective changes of reflux symptoms; ② distal esophageal manometry and 24-hour pH monitoring after operation; ③ progression of esophageal mucosal lesions. Patients were followed up using outpatient examination and telephone interview with questionnaire at one month after operation and gastroscopy every 6 months up to June 2018. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range). Results (1) Surgical and postoperative recovery situations: of 12 patients, 7 underwent laparoscopic Nissen fundoplication and 5 underwent laparoscopic Dor fundoplication. Seven patients complicated with esophageal hiatal hernia underwent laparoscopic repair of esophageal hiatal hernia, without conversion to open surgery. Operation time, volume of intraoperative blood loss and duration of hospital stay were (98±21)minutes, (27±13)mL, (2.3±1.2)days. There were no intraoperative and postoperative severe complications in the 12 patients. (2) Follow-up: 12 patients were followed up for 20-42 months with a average time of 32 months. ① Subjective changes of reflux symptoms: 12 patients completed questionnaires at one month after operation. Scores of heartburn in the 12 patients were 0. Acid regurgitation in the 12 patients was relieved, requiring no acid-inhibitory drugs. Upper abdominal dull pain in 3/4 of the patients and retrosternal pain in 2 patients were relieved. Patients had mild dysphagia or abdominal distention at 2 weeks after operation and recovered to normal diet by dietary instruction within 4 weeks. Score of dysphagia was 2 (range, 0-4) and no patient need hospitalization or surgical treatment. Score of surgery satisfaction was 9 (range, 7-10) in the patients. ② Distal esophageal manometry and 24-hour pH monitoring after operation: lower esophageal sphincter pressure and DeMeester score were (12.8±2.8)mmHg (1 mmHg=0.133 kPa) and 11±3 respectively. ③ Progression of esophageal mucosal lesions: 2 of 9 patients with short Barrett′s esophagus were detected complete regression of esophageal mucosal lesions at postoperative one year, 1 was detected partial regression of esophageal mucosal lesions at postoperative one year and 6 were detected no change at postoperative 2 years. One of 3 patients with long Barrett′s esophagus was detected partial regression of esophageal mucosal lesions at postoperative one year and 2 complicated with mild poor differentiation were detected no change at postoperative 2 years. Conclusion Laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett′s esophagus can improve subjective symptom and objective markers of patients and provide satisfactory efficacy. Key words: Barrett′s esophagus; Gastroesophageal reflux disease; Anti-reflux surgery; Fundoplication; Laparoscopy; Efficacy