Outcome Of Laparoscopic Fundoplication Research Articles

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.

Perioperative outcomes of laparoscopic fundoplication for gastroesophageal reflux disease in children with or without scoliosis.

This study aimed to evaluate the perioperative outcomes of laparoscopic fundoplication (LF) for gastroesophageal reflux disease (GERD) in children with scoliosis. Data of consecutive patients with GERD who underwent LF from January 2015 to December 2020 at a single pediatric institution were retrospectively analyzed. Eighty-two patients underwent laparoscopic Nissen fundoplication. The median [interquartile range (IQR)] body weight was 9.3 [7; 14] kg. Seventy-five patients wereneurologically impaired (91%), and other comorbidities included scoliosis (n = 33), lung disease (n = 39), and cardiac disease (n = 14). The median (IQR) operative time including the creation of the gastrostomy and volume of bleeding were 160 [143; 190] min and 2 [1; 5] mL, respectively. There were no significant differences between patients with and those without scoliosis (p = 0.17 and p = 0.90, respectively). Patients with cardiac disease had a longer operative time (167 [161; 193] vs. 157 [141; 190] min, p = 0.01). There were three post-operative complications in children with neurological impairment; however, there was no clear relationship between the severity of scoliosis and complications. Severity of scoliosis did not correlate with perioperative results and post-operative complications. This suggests that the same LF technique can be used regardless of the presence or absence of scoliosis in children.

RA06.03: SURGICAL OUTCOMES OF GIANT HIATAL HERNIA REPAIR IN PATIENTS OVER THE AGE OF 80

Abstract Background Patients with giant hiatal herniae are often symptomatic and have significantly reduced quality of life (QoL). Laparoscopic fundoplication is an established treatment of giant hiatal hernia. Advanced age has been previously shown to be the most significant predictor of mortality and morbidity in hiatal hernia repair. Reported outcomes of laparoscopic fundoplication in patients over the age of 80 are limited to case reports and small case series. Methods Data was extracted from a prospectively populated single surgeon database of laparoscopic fundoplication procedures between 1995 and 2014. Patients who were operated for giant HH (&gt; 30% of stomach in the chest) that were aged 80 or older at the time of surgery were included. Quality of life (QOL) data was collected pre-operatively, in early post-operative period (within 12 months) and late post-operative period (24 months or later). QOL data included gastro-intestinal quality of life index (GIQLI), Visick score, dysphagia score and overall satisfaction with surgery. Search of Ryerson index (was conducted to establish month and year of death and calculate post-operative life expectancy. Results Inclusion criteria were met by 89 patients. Average age was 84 (80–93). The proportion of herniated stomach was 70.9% on average (range 30–100%; SD 27.25), the hiatal defect was large in all patients. There was 1 perioperative death from myocardial infarction at 30 days after surgery. There were no other major complications (Clavien-Dindo Grade III-IV). Post-operative survival was an average of 74.5 months (SD 47.8; range 1–233). GIQLI was reduced pre-operatively (mean 91.8; SD 19.4). There was improvement in GIQLI scores on early (mean 101.45; SD 21.2) and late (mean 106.7; SD 19.2; P = 0.005) post-operative follow up. Pre-operative Visick scores (mean 2.92; SD 0.98) have improved significantly in early (mean 1.94; SD 0.97; P = 0.000) and late (mean 2.03; SD 0.99; P = 0.001) post-operative periods. During early post-operative follow up 97% of the patients were satisfied with overall outcome of their operation, whilst 3% were dissatisfied. Overall satisfaction scores remained high on late follow up (93.3% satisfied, 6.7% dissatisfied). Conclusion Findings of this study demonstrate that in carefully selected patients with giant HH surgery is safe and results in improved quality of life post operatively. Disclosure All authors have declared no conflicts of interest.

PS01.063: THE EFFECT OF DISEASE DURATION ON SURGICAL OUTCOMES FOR PATIENTS WITH EROSIVE GERD TREATED BY LAPAROSCOPIC SURGERY

Abstract Background Erosive gastro-esophageal reflux disease (e-GERD) is associated with various symptoms caused by reflux of acid and gastric contents from the stomach to the esophagus. In general, it seems that as the duration of the disease is longer, surgical outcomes are inferior because of disease progression. The aim of this study is to evaluate the relationship between the disease duration and surgical outcomes of laparoscopic fundoplication (LF). Methods Two hundred and fifty-one (mean age was 53.4 years, male in 166) patients with e-GERD who underwent LF as an initial operation at our institution were extracted from the database. E-GERD was defined as equal to or more than grade A esophagitis by Los Angeles classification. These patients were divided into three groups by the length of disease duration: less than two years in Group A (n = 104), two to 5 years in Group B (n = 68) and equal to or more than 5 years in Group C (n = 79). We analyzed patients’ background, pre-operative symptoms, surgical outcomes, patients’ satisfaction and post-operative course. Before surgery, a standardized questionnaire was used to assess the degree of frequency and severity of symptoms (heartburn, regurgitation, dysphagia, vomiting and chest pain). Moreover, satisfaction with the operation was evaluated using the standardized questionnaire. Results Age and degree of acid reflux by pH-metry were significantly different among the three groups (P = 0.0054 and 0.0345, respectively). As to the pre-operative symptom score, the severity score of heartburn and the frequency score of regurgitation were significantly lower in Group A (P = 0.0225 and 0.031, respectively). Although operation time was significantly difference among the three groups (P = 0.0423), there were no differences in intraoperative blood loss, occurrence of peri-operative complications, post-operative course and patients’ satisfaction. Conclusion Although the patients who suffered equal to or over two years had more severe heartburn and regurgitation because of prolonged acid reflux, the duration of the disease does not seem to affect the surgical outcomes. Disclosure All authors have declared no conflicts of interest.

Effects of the body mass index (BMI) on the surgical outcomes of laparoscopic fundoplication for gastro-esophageal reflux disease: a propensity score-matched analysis.

In the present study, we examined how the body mass index (BMI) affected the outcomes of laparoscopic fundoplication for GERD in patients, whose backgrounds were matched in a propensity score-matched analysis. We divided the patients into two groups (BMI<25kg/m2 and BMI≥25kg/m2). The following background information was matched for the propensity score-matched analysis: sex, age, degree of esophageal hiatal hernia, acid exposure time, and degree of reflux esophagitis. In total, 105 subjects were extracted in each group. The surgical outcomes and postoperative outcomes of patients with BMI<25kg/m2 (Group A) and those with BMI≥25kg/m2 (Group B) were compared and examined. There were no differences in the surgical procedure, intraoperative complications, or estimated blood loss (p=0.876, p=0.516, p=0.438, respectively); however, the operative time was significantly prolonged in Group B (p=0.003). The rate of postoperative recurrence in Group A was 17% (15/87 patients), while that in Group B was 11% (12/91 patients), and did not differ to a statistically significant extent (p=0.533). Although the operative time for GERD in obese patients was prolonged in comparison with non-obese patients, there was no difference in the rate of postoperative recurrence.

Diagnosis and treatment of benign inflammatory esophageal diseases

Nowadays, benign inflammatory esophageal diseases represent a rising socioeconomic burden. Recently, novel therapeutic approaches have been introduced to enrich personalized surgical options. A PubMed research was conducted and merged with institutional guidelines and data. Magnetic sphincter augmentation strengthens the lower esophageal sphincter and therefore recreates the natural reflux barrier. Electrical sphincter stimulation offers the possibility to personalize minimal invasive treatment and considers even changing lifestyles. Endoscopic antireflux procedures try to mimic the outcome of laparoscopic fundoplication and aim to improve the angle of His. However, laparoscopic fundoplication remains the surgical treatment of choice in advanced reflux disease. Reflux can also cause eosinophilic infiltration and therefore hinders diagnosis of eosinophilic esophagitis. Once diagnosis is established, dietary modifications and topical steroids offer relevant relief. Reflux produces Barrett’s esophagus, a neoplastic progression, which is commonly treated with radiofrequency ablation. Novel therapeutic options are facing the rising incidence of benign inflammatory diseases.

Outcomes of laparoscopic fundoplication with the use of bio-mesh in patients with gord or large symptomatic hiatal hernias

Outcomes of laparoscopic fundoplication with the use of bio-mesh in patients with gord or large symptomatic hiatal hernias

Laparoscopic fundoplication for neurologically impaired adolescents with severe scoliosis

Abstract Laparoscopic antireflux procedure for patients with severe scoliosis is often challenging, as the esophageal hiatus lies in an extremely deep position and is frequently rotated. Reports regarding the clinical results of laparoscopic fundoplication are scarce, especially in patients with severe scoliosis. In this study, laparoscopic Nissen fundoplication was applied to seven adolescent patients aged between 19 and 29 years with neurological impairment and gastroesophageal reflux disease (GERD). The scoliosis among them was considerably severe with a median Cobb angle of 131°. Follow-up was conducted with a median period of 7.8 years. There was no intraoperative complication or recurrence of GERD. Two patients required tracheostomy, and one died due to recurrent pneumonia after fundoplication. Our experience suggested the feasibility of laparoscopic Nissen fundoplication with an arrangement of port layout even in neurologically impaired adolescents with severe scoliosis. As recurrent aspiration pneumonia can persist after fundoplication in some patients, an anti-aspiration procedure may be considered to achieve a higher quality of life.

Body mass index has no effect on the results of laparoscopic fundoplication in Japanese patients with reflux esophagitis

Background The influence of obesity on the outcome of laparoscopic fundoplication is yet to be determined. Furthermore, results of fundoplication in Japanese patients have not been reported. Accordingly, we examined whether obesity affects the outcome of laparoscopic fundoplication in Japanese patients.

Impact of Gender and Age on the Long‐Term Outcome of Laparoscopic Fundoplication

It has been suggested that gender and age could be factors that influence the likelihood of success following antireflux surgery, and our anecdotal impression has been that the outcome following Nissen fundoplication in older women is often disappointing. If correct, characterization of the extent of any differences in outcome might help patient selection and, hence, surgical outcomes. Therefore, in this study we investigated the impact of gender and age on longer-term clinical outcomes following laparoscopic fundoplication. Perioperative and follow-up data from patients undergoing laparoscopic fundoplication in our departments have been collected prospectively and stored in a database. From the database, patients who had undergone either an anterior 180 degrees partial or 360 degrees total laparoscopic fundoplication for gastroesophageal reflux and completed 5 years clinical follow-up were identified. Patients were classified according to gender and age, and outcome data were analyzed to determine differences. Analog scales of 0-10 were used to determine symptoms of heartburn and dysphagia and overall satisfaction. Seven hundred three patients were studied (58% males). Females were less satisfied with the outcome (score = 7.8 +/- 2.8 vs. 8.4 +/- 2.5, P = 0.0036), and had higher scores for heartburn (2.0 +/- 2.7 vs. 1.2 +/- 2.2; P = 0.0001) and dysphagia for solid food (2.7 +/- 2.9 vs. 2.0 +/- 2.5, P = 0.0049) compared to males. Revisional procedures were undertaken more frequently in females (15.5% vs. 8.4%, P = 0.0038). Age had no impact on any clinical outcome. While the outcome for laparoscopic fundoplication is not influenced by age, the outcome for women is poorer than in males.

Influence of psychopathological changes on quality of life after laparoscopic fundoplication for the treatment of gastroesophageal reflux

There are references in medical literature to the influence of psychopathological changes and their negative impact on the results of laparoscopic fundoplication. The objective of this study is to analyze the influence of psychological changes, as assessed by the General Health Questionnaire-28 (GHQ-28), on patients undergoing surgery for gastroesophageal reflux. This is a prospective study in a series of 103 consecutive patients (62 males and 41 females with a mean age of 40 years) undergoing laparoscopic fundoplication. In addition to functional studies, patients completed the SF-36, Gastrointestinal Quality of Life Index, and GHQ-28 before surgery. Functional tests and questionnaires were repeated 6 months after surgery. Patients were also questioned about their degree of satisfaction. Postoperative results of patients with a normal GHQ-28 and patients showing psychopathological changes as defined by the GHQ-28 questionnaire before surgery were compared. Overall, all patients experienced an improvement in their quality of life. Forty-one patients showed a pathological result in the preoperative GHQ-28 questionnaire. No differences were found in functional results and degree of satisfaction with surgery between patients with normal and pathological results in the preoperative GHQ-28 questionnaire. However, patients with a pathological result in the preoperative GHQ-28 had poorer results in all domains of the postoperative Gastrointestinal Quality of Life Index and SF36 quality of life questionnaires as compared to patients with a normal preoperative GHQ-28 questionnaire. Patients with pathological results in the preoperative GHQ-28 had poorer results in terms of postoperative quality of life despite having normal postoperative physiological studies; this decreased quality of life did not have an impact on the degree of satisfaction with surgery performed. The GHQ-28 does not therefore appear to serve as a predictor of postoperative satisfaction.

Lung transplantation in patients with connective tissue disorders and esophageal dysmotility

Lung and esophageal dysfunction are common in patients with connective tissue disease (CTD). Recent reports have suggested a link between pathologic gastroesophageal reflux and bronchiolitis obliterans syndrome (BOS) after lung transplant. Because patients with CTD have a high incidence of esophageal dysmotility and reflux, this group may be at increased risk of allograft dysfunction after lung transplantation. Little is known about antireflux surgery in these patients. Our aims were to describe: (i) the esophageal motility and reflux profile of patients with CTD referred for lung transplantation; and (ii) the safety and outcomes of laparoscopic fundoplication in this group. A retrospective review of 26 patients with CTD referred for lung transplantation between July 2003 and June 2007 at a single center. Esophageal studies included manometry and ambulatory 24-h pH monitoring. Twenty-three patients had esophageal manometry and ambulatory 24-h pH monitoring. Nineteen patients (83%) had pathologic distal reflux and 7 (30%) also had pathologic proximal reflux. Eighteen patients (78%) had impaired or absent peristalsis. Eleven of 26 patients underwent lung transplantation. Ten patients are alive at a median follow-up of 26 months (range 3-45) and one has bronchiolitis obliterans syndrome-1. Six patients had a laparoscopic fundoplication, 1 before transplantation and 5 after. All fundoplication patients are alive at median follow-up of 25 months (range 19-45). In conclusion, esophageal dysmotility and reflux are common in CTD patients referred for lung transplant. For this group, laparoscopic fundoplication is safe in experienced hands.

P1: Outcomes of laparoscopic fundoplication vs. laparoscopic gastric bypass in morbidly obese with gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is commonly associated with morbid obesity. Laparoscopic fundoplication is the standard surgical treatment for GERD. However, laparoscopic gastric bypass has shown to effectively resolve GERD symptoms in morbidly obese. The outcomes of laparoscopic fundoplication and gastric bypass in morbidly obese with GERD were compared at US academic medical centers.

Symptom-focused results after laparoscopic fundoplication for refractory gastroesophageal reflux disease—a prospective study

Symptoms of gastroesophageal reflux disease (GERD) are common in the general population. Although the results of laparoscopic fundoplication are well documented, there have been no reports on the operative outcome in patients refractory to or with only partial response to medical therapy for GERD. Thirty-two patients with GERD, whose continuous high doses of medical treatment with proton-pump inhibitors produced no or only partial symptom relief, underwent laparoscopic Nissen fundoplication. Symptoms were evaluated with a standardized questionnaire preoperatively and 12 months after surgery. The complete follow-up evaluation was obtained in 30 out of the 32 patients. The main symptoms before surgery were regurgitation (93%), heartburn (60%), epigastric pain (47%), and globus sensation (47%). All patients were relieved from heartburn, vomiting, and globus sensation. Dysphagia was relieved in 75% of the patients and regurgitation in 86%. Dysphagia as a new symptom occurred in 9%. The overall morbidity rate was 16%. Patient satisfaction rate was 87%. Laparoscopic fundoplication seems to be an effective treatment for severe, drug-resistant GERD. The high patient satisfaction rate and the positive therapeutic response in 95% of patients justify this procedure in this strictly selected group of patients.

Review article: the role of surgery in gastro‐oesophageal reflux disease

Rates for laparoscopic fundoplication are declining in the United States and there is no consensus on the indications for referral to surgery in gastro-oesophageal reflux disease. To highlight recent studies on the outcomes of laparoscopic fundoplication in adults that cast doubt on the traditional indications for surgery in reflux disease. Patients who are well maintained on medical therapy have more to lose with surgical intervention than to gain, and should not be offered surgery. Likewise, the notion that surgery prevents oesophageal cancer is a hypothesis that is not supported by current evidence, therefore surgical intervention should not be offered to these patients. The only clear-cut candidates for surgery include: patients with anatomic abnormalities such as a large hiatus hernia, or those with persistent regurgitation that causes troublesome symptoms despite medical therapy; and carefully selected patients with extra-oesophageal disorders who have symptoms of reflux disease such as heartburn and regurgitation, an incomplete response to medical therapy and persistent plus demonstrable reflux on pH or impedance testing that is associated with their symptoms. Patients should be aware of the high likelihood of needing continued acid inhibitory therapy following surgery and the possibility of side-effects. Only a few carefully selected patients should undergo fundoplication for reflux disease.

Gastroesophageal reflux disease (GERD) and chest pain. Results of laparoscopic antireflux surgery.

Laparoscopic fundoplication cures heartburn and regurgitation in patients with gastroesophageal reflux disease (GERD) but its effect on the chest pain that is also experienced by some patients is less clear. Confusion stems from the fact that it is difficult to determine preoperatively whether the chest pain is actually caused by the reflux. Therefore, we designed a study in patients with GERD and chest pain that would assess the value of pH monitoring in establishing a correlation between the symptom and the disease, the predictive value of pH monitoring on the results of surgical treatment, and the outcome of laparoscopic fundoplication on chest pain in patients with GERD. Of 487 patients who underwent laparoscopic fundoplication for GERD at our institution between October 1992 and July 2000, 165 (34%) complained of chest pain in addition to heartburn and regurgitation. Their symptoms had been present for an average of 118 months. The pH monitoring tracings were analyzed for a correlation between episodes of reflux and chest pain. The mean length of follow-up was 13 months. Among the 165 patients with chest pain, the relationship between pain and reflux during pH monitoring was as follows: 39 patients (group A) experienced no chest pain during the study; in 28 patients (group B), chest pain correlated with reflux in <40% of instances; in 98 patients (group C), chest pain correlated with reflux in ?40% of instances. Chest pain improved postoperatively in 65% of group A patients, 79% of group B patients, and 96% of group C patients (group C vs A and B: p <0.05). Heartburn and regurgitation resolved or improved in 97% and 95% of patients, respectively. These data show that pH monitoring helped to identify a relationship between chest pain and reflux; and when the two coincided, the chest pain was relieved by antireflux surgery.

The outcome of laparoscopic fundoplication for reflux disease in communlity practice in the USA

The outcome of laparoscopic fundoplication for reflux disease in communlity practice in the USA

The outcome of laparoscopic fundoplication for reflux disease in communlity practice in the USA

The outcome of laparoscopic fundoplication for reflux disease in communlity practice in the USA

Early satiety in GERD patients may be predictive of an unsatisfactory outcome of laparoscopic fundoplication

Early satiety in GERD patients may be predictive of an unsatisfactory outcome of laparoscopic fundoplication

Preoperative les pressure is the best predictor of outcome of laparoscopic fundoplication for ger disease

Preoperative les pressure is the best predictor of outcome of laparoscopic fundoplication for ger disease