Outcome Of Antireflux Surgery Research Articles

Minimally invasive surgery for gastroesophageal reflux disease

Background: The goal of this study was to determine if the outcome of antireflux surgery can be improved by: (1) conducting a careful preoperative workup to characterize gastroesophageal reflux disease (GERD) in the individual patient; and (2) tailoring the operation to the results of the preoperative function tests. Patients and methods: Sixty-eight patients had operations for GERD by minimally invasive techniques. Results: A Rossetti fundoplication was performed in 22 patients. Sixty-eight percent became asymptomatic. Twenty-seven percent developed dysphagia or gas bloat. Thirty-five patients had a Nissen fundoplication. Ninety-one percent are asymptomatic. Eleven patients with severe abnormalities of esophageal peristalsis underwent a Guarner fundoplication with relief of symptoms in 82% of patients. No patients in the Nissen or Guarner group developed postoperative persistent dysphagia or gas bloat. A pyloromyotomy was performed in 3 patients because of severe delayed gastric emptying. Conclusions: Minimally invasive surgery for GERD gives good-to-excellent results even in patients with abnormal esophageal body function, provided that the operation is tailored to the individual patient based on the results of the preoperative function tests.

Prognostic Value of Esophageal Manometry in Antireflux Surgery in Childhood

To assess the predictive value of preoperative esophageal manometric study in the outcome of antireflux surgery, 14 children with severe gastroesophageal reflux (GER) who underwent surgery were studied retrospectively. Five patients had neuromuscular disease; one had been operated on for esophageal atresia. After extended (> 20 h) esophageal pH monitoring and/or barium swallow study, all patients underwent preoperative manometric study. After surgery, the patients were followed for 4 months to 4 years. Functional complications were noted after mechanical complications were eliminated. All patients had normal upper esophageal sphincter pressure (UESp); the resting lower esophageal sphincter pressure (LESp) was decreased in four patients, and seven had esophageal body motility trouble. Functional complications occurred in two patients. One was a neurologically involved patient who had had a normal preoperative manometric study; the other was the patient who had been operated on for esophageal atresia. No complications occurred in four patients who had had abnormal preoperative manometric studies. We conclude that, in this group of patients, esophageal manometric study has no predictive value in the outcome of the surgical procedure; however, it still would be interesting to elucidate the mechanisms of GER, especially in congenital abnormalities such as esophageal atresia.

Gas bloat syndrome: an avoidable outcome of anti-reflux surgery?

Gas bloat syndrome: an avoidable outcome of anti-reflux surgery?

Renal function and growth after antireflux surgery in children.

The outcome of antireflux surgery for vesico-ureteral reflux (VUR) was studied in 39 children (65 renal units). The T max of the renogram improved significantly after operations in 51 (78.5%) of the 65 renal units due to a reduction of the back pressure. Improvements in scarring were observed in only 3 (7.3%) of 41 scarred kidneys. The growth of 38 kidneys was examined using the renal ratio, more than 2 years (mean, 3 years and 1 month) after the operation. The normal renal ratio was restored in 1 of 12 small kidneys with a preoperative size of less than the mean -2SD. The other 11 kidneys remained small, but 6 of these grew with a normal growth curve. The growth of the remaining 5 kidneys was unremarkable. Of the 26 kidneys with a normal renal ratio, 4 became small after the operation, but all the others had growth within the normal range.

Long-term follow-up of surgery for gastroesophageal reflux in infants and children

Surgery for gastroesophageal reflux in infants and children has been shown to be safe and effective, but long-term results of the surgery have not been investigated. Because studies in adults show objective evidence of recurrent reflux five years postoperatively, we recalled 25 children for long-term follow-up of surgery. The preoperative symptoms of vomiting, apnea, pneumonia, and hematemesis were permanently controlled in all patients. Failure to thrive was reversed in all patients except those with multiple malformations. Extended esophageal pH monitoring revealed only one patient with symptomatic recurrent reflux. As a group, the children had significantly less reflux as measured by extended pH monitoring than did controls. Thirty-six percent of patients had mild to moderate symptoms of gas bloat. Thirty-two percent were described as very slow to finish most meals. Twenty-eight percent were unable to burp or vomit. Twenty-five percent choked on some solids. These symptoms did not correlate with the type of operation performed. Long term outcome of antireflux surgery in children is better than in adults.