|
1
|
Harsányi L, Kincses Z, Altorjay Á. Acid Reflux Management with the RefluxStop Implant: A Prospective Multicenter Trial with 3-Year Outcomes. Dig Dis Sci 2025; 70:665-674. [PMID: 39702779 PMCID: PMC11839859 DOI: 10.1007/s10620-024-08788-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Accepted: 12/04/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND RefluxStop is a unique implant for laparoscopic treatment of gastroesophageal reflux disease (GERD). It restores normal function of the gastroesophageal junction without the unwanted effects of encircling the esophagus, circumventing adverse events (AEs) associated with conventional anti-reflux surgeries. METHODS Three-year follow-up of 50 patients with chronic GERD treated by RefluxStop was achieved in a prospective, single-arm, multicentric clinical trial analyzing safety and effectiveness of the procedure. RESULTS The 3-year results included 47 of 50 patients. No cases of device-related AEs, erosion, device migration, or explantation occurred during the entire study period. Two AEs were reported between the 1- and 3-year results (1-year results previously published), including mild dysphagia (n = 1) and heartburn (n = 1). No subjects (n = 0/47) required regular daily proton pump inhibitor (PPI) therapy at 3-year follow-up. Subjects experienced a 93.1% reduction in median total GERD-HRQL score at 3 years (2.0) from baseline (29.5). One subject (n = 1) was dissatisfied with treatment but demonstrated normal 24-h pH monitoring results. Daily regurgitation improved by 97.9% from a baseline of 86% (n = 43/50) to 2.1% (n = 1/47) at follow-up. Dysphagia GERD-HRQL subscore of > 2 (i.e., bothersome everyday) decreased from 22% at baseline to 2% at 3 years. Baseline odynophagia (16%) completely resolved at 3 years. CONCLUSION RefluxStop surgery treats GERD without encircling and applying pressure on the esophagus. Three-year follow-up demonstrates that the device is safe and effective in treating GERD with substantial improvements in quality of life via GERD-HRQL (median improvement 93%), PPI usage (0%), and 98% without dysphagia.
Collapse
Affiliation(s)
- László Harsányi
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Üllői Út 78., Budapest, H-1082, Hungary.
| | - Zsolt Kincses
- General Surgery Department, University of Debrecen Kenézy Gyula Teaching Hospital, Debrecen, Hungary
| | - Áron Altorjay
- Surgical Department, Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary
| |
Collapse
|
|
2
|
Baettig SJ, Fend RR, Gero D, Gutschow C, Schlaepfer M. Postoperative exacerbated cough hypersensitivity syndrome induces dramatic respiratory alkalosis, lactatemia, and electrolyte imbalance. BMC Anesthesiol 2024; 24:323. [PMID: 39261779 PMCID: PMC11389337 DOI: 10.1186/s12871-024-02695-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND The perioperative management of patients with chronic cough or cough hypersensitivity syndrome and its sometimes severe effects is currently under-researched and under-reported. CASE PRESENTATION A 46-year-old female patient with a history of chronic cough and Cough Hypersensitivity Syndrome. After laparoscopic hiatoplasty and anterior fundoplication under general anesthesia, experienced a pronounced exacerbation of coughing symptoms. Despite prompt and extensive treatment involving antitussives, inhalants, anxiolytics, and sedatives, the symptoms remained uncontrollable. Within a few hours, the patient developed a respiratory alkalosis with severe and life-threatening electrolyte shift (pH 7.705, pCO2 1.72 kPa, K+ 2.1 mmol/l). Lactatemia lasted for more than 12 hours with values up to 6.6 mmol/l. Acute bleeding, pneumothorax, and an acute cardiac event were ruled out. Deep analgosedation and inhalation of high-percentage local anesthetics were necessary to manage the clinical symptoms. CONCLUSIONS This case highlights the challenging nature of chronic cough and hypersensitivity syndrome perioperatively. A tailored anesthesiologic approach, exclusion of other provoking medical problems, and knowledge of possible management and treatment options are key.
Collapse
Affiliation(s)
- Sascha Jan Baettig
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
| | | | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christian Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Martin Schlaepfer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
|
3
|
Ivy ML, Farivar AS, Baison GN, Griffin C, Bograd AJ, White PT, Louie BE. Morbidity and mortality after antireflux and hiatal hernia surgery across a spectrum of ages. J Gastrointest Surg 2024; 28:1302-1308. [PMID: 38821211 DOI: 10.1016/j.gassur.2024.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/11/2024] [Accepted: 05/27/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Antireflux surgery (ARS) and hiatal hernia repair (HHR) are common surgical procedures with modest morbidity. Increasing age is a risk factor for complications; however, details regarding acute morbidity are lacking. This study aimed to describe the incidence rates and types of morbidities across the spectrum of ages. METHODS A total of 2342 consecutive cases were retrospectively reviewed from 2003 to 2020 for 30-day complications. All complications were assessed using the Clavien-Dindo (CD) grading system. Patients were divided into 5 age groups: ≤59, 60 to 69, 70 to 79, 80 to 89, and ≥90 years. RESULTS The numbers per age group were 1100 patients aged ≤59 years, 684 patients aged 60 to 69 years, 458 patients aged 70 to 79 years, 458 patients aged 80 to 89 years, and 6 patients aged ≥90 years. A total of 427 complications (18.2%) occurred, including 2 mortalities, each in the 60- to 69-year age group and the 70- to 79-year age group, for a mortality rate of 0.2%. The complication rate increased from 13.5% (149) in patients aged ≤59 years to 35.0% (35) in patients aged ≥80 years (P = .006), with CD grades I and II accounting for >70% of complications, except in patients aged ≥80 years (57.1%). CD grades IIIa and IIIb were higher in patients aged ≥80 years (26.5% [P = .001] and 11.8% [P = .021], respectively). CD grade IVa and IVb complications were rare overall. CONCLUSION There is a modest rate of morbidity that increases as patients age, regardless of hernia type, elective or primary surgery, with most being minor complications (CD grade≤II). Our data should help patients, referring physicians, and surgeons counsel patients regarding the effect of increasing age in ARS and HHR.
Collapse
Affiliation(s)
- Megan L Ivy
- Division of Thoracic Surgery, Swedish Medical Center Cancer and Digestive Health Institutes, Seattle, Washington State, United States
| | - Alexander S Farivar
- Division of Thoracic Surgery, Swedish Medical Center Cancer and Digestive Health Institutes, Seattle, Washington State, United States
| | - George N Baison
- Division of Thoracic Surgery, Swedish Medical Center Cancer and Digestive Health Institutes, Seattle, Washington State, United States
| | - Cassandra Griffin
- Division of Thoracic Surgery, Swedish Medical Center Cancer and Digestive Health Institutes, Seattle, Washington State, United States
| | - Adam J Bograd
- Division of Thoracic Surgery, Swedish Medical Center Cancer and Digestive Health Institutes, Seattle, Washington State, United States
| | - Peter T White
- Division of Thoracic Surgery, Swedish Medical Center Cancer and Digestive Health Institutes, Seattle, Washington State, United States
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Medical Center Cancer and Digestive Health Institutes, Seattle, Washington State, United States.
| |
Collapse
|
|
4
|
Lee WG, Evans LL, Johnson SM, Woo RK. The Evolving Use of Magnets in Surgery: Biomedical Considerations and a Review of Their Current Applications. Bioengineering (Basel) 2023; 10:bioengineering10040442. [PMID: 37106629 PMCID: PMC10136001 DOI: 10.3390/bioengineering10040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
The novel use of magnetic force to optimize modern surgical techniques originated in the 1970s. Since then, magnets have been utilized as an adjunct or alternative to a wide array of existing surgical procedures, ranging from gastrointestinal to vascular surgery. As the use of magnets in surgery continues to grow, the body of knowledge on magnetic surgical devices from preclinical development to clinical implementation has expanded significantly; however, the current magnetic surgical devices can be organized based on their core function: serving as a guidance system, creating a new connection, recreating a physiologic function, or utilization of an internal–external paired magnet system. The purpose of this article is to discuss the biomedical considerations during magnetic device development and review the current surgical applications of magnetic devices.
Collapse
Affiliation(s)
- William G. Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Lauren L. Evans
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Sidney M. Johnson
- Department of Surgery, University of Hawaii, Honolulu, HI 96822, USA
| | - Russell K. Woo
- Department of Surgery, University of Hawaii, Honolulu, HI 96822, USA
| |
Collapse
|
|
5
|
Zhang C, Pan C, Chan KF, Gao J, Yang Z, Leung KKC, Jin D, Wang Y, Xia N, Ning Z, Wang X, Jiang S, Zhang Z, Wang Q, Hao B, Chiu PWY, Zhang L. Wirelessly powered deformable electronic stent for noninvasive electrical stimulation of lower esophageal sphincter. SCIENCE ADVANCES 2023; 9:eade8622. [PMID: 36888700 PMCID: PMC9995080 DOI: 10.1126/sciadv.ade8622] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Electrical stimulation is a promising method to modulate gastrointestinal disorders. However, conventional stimulators need invasive implantation and removal surgeries associated with risks of infection and secondary injuries. Here, we report a battery-free and deformable electronic esophageal stent for wireless stimulation of the lower esophageal sphincter in a noninvasive fashion. The stent consists of an elastic receiver antenna infilled with liquid metal (eutectic gallium-indium), a superelastic nitinol stent skeleton, and a stretchable pulse generator that jointly enables 150% axial elongation and 50% radial compression for transoral delivery through the narrow esophagus. The compliant stent adaptive to the dynamic environment of the esophagus can wirelessly harvest energy through deep tissue. Continuous electrical stimulations delivered by the stent in vivo using pig models significantly increase the pressure of the lower esophageal sphincter. The electronic stent provides a noninvasive platform for bioelectronic therapies in the gastrointestinal tract without the need for open surgery.
Collapse
Affiliation(s)
- Chong Zhang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Chengfeng Pan
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- The State Key Laboratory of Fluid Power and Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, P. R. China
| | - Kai Fung Chan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Multi-Scale Medical Robotics Center, Hong Kong Science Park, Shatin, New Territories, Hong Kong SAR, China
| | - Jinyang Gao
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Zhengxin Yang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Kevin Kai Chung Leung
- Multi-Scale Medical Robotics Center, Hong Kong Science Park, Shatin, New Territories, Hong Kong SAR, China
| | - Dongdong Jin
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Yuqiong Wang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Neng Xia
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Zhipeng Ning
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Xin Wang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Shuai Jiang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Zifeng Zhang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Qinglong Wang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Bo Hao
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Philip Wai Yan Chiu
- Chow Yuk Ho Technology Center for Innovative Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Multi-Scale Medical Robotics Center, Hong Kong Science Park, Shatin, New Territories, Hong Kong SAR, China
- Department of Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Li Zhang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Multi-Scale Medical Robotics Center, Hong Kong Science Park, Shatin, New Territories, Hong Kong SAR, China
- Department of Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| |
Collapse
|
|
6
|
Abstract
BACKGROUND Dysphagia remains the most significant concern after anti-reflux surgery, including magnetic sphincter augmentation (MSA). The aim of this study was to evaluate postoperative dysphagia rates, its risk factors, and management after MSA. METHODS From a prospectively collected database of all 357 patients that underwent MSA at our institution, a total of 268 patients were included in our retrospective study. Postoperative dysphagia score, gastrointestinal symptoms, proton pump inhibitor intake, GERD-HRQL, Alimentary Satisfaction, and serial contrast swallow imaging were evaluated within standardized follow-up appointments. To determine patients' characteristics and surgical factors associated with postoperative dysphagia, a multivariable logistic regression analysis was performed. RESULTS At a median follow-up of 23 months, none of the patients presented with severe dysphagia, defined as the inability to swallow solids or/and liquids. 1% of the patients underwent endoscopic dilatation, and 1% had been treated conservatively for dysphagia. 2% of the patients needed re-operation, most commonly due to recurrent hiatal hernia. Two patients underwent device removal due to unspecific discomfort and pain. No migration of the device or erosion by the device was seen. The LINX® device size ≤ 13 was found to be the only factor associated with postoperative dysphagia (OR 5.90 (95% CI 1.4-24.8)). The postoperative total GERD-HRQL score was significantly lower than preoperative total score (2 vs. 19; p = 0.001), and daily heartburn, regurgitations, and respiratory complains improved in 228/241 (95%), 131/138 (95%) and 92/97 (95%) of patients, respectively. CONCLUSIONS Dysphagia requiring endoscopic or surgical intervention was rare after MSA in a large case series. LINX® devices with a size < 13 were shown to be an independent risk factor for developing postoperative dysphagia.
Collapse
|
|
7
|
Nikolic M, Matic A, Feka J, Gensthaler L, Kristo I, Osmokrovic B, Riegler FM, Mosleh BO, Schoppmann SF. Expanded Indication for Magnetic Sphincter Augmentation: Outcomes in Weakly Acidic Reflux Compared to Standard GERD Patients. J Gastrointest Surg 2022; 26:532-541. [PMID: 34590216 PMCID: PMC8926968 DOI: 10.1007/s11605-021-05152-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic sphincter augmentation (MSA) is a modern surgical anti-reflux technique with proven efficacy and low postoperative morbidity in patients with acidic reflux. The aim of this retrospective review study was to evaluate the symptomatic outcome of MSA in patients with weakly acidic reflux. METHODS From a prospectively collected clinical database, comprising all 327 patients that underwent MSA at our institution, a total of 67 patients with preoperative weakly acidic reflux measured in the 24-h impedance-pH-metry were identified. Postoperative gastrointestinal symptoms, proton pump inhibitor intake (PPI), GERD Health-Related Quality-of-Life (GERD-HRQL), alimentary satisfaction (AS), and patients' overall satisfaction were evaluated within highly standardized follow-up appointments. Furthermore, outcome of these patients was compared to the postoperative outcome of a comparable group of patients with a preoperative acidic reflux. RESULTS At a median follow-up of 24 months, none of the patients with weakly acidic reflux presented with persistent dysphagia, or underwent endoscopic dilatation or reoperation. The postoperative GERD-HRQL score was significantly reduced (2 vs. 20; p = 0.001) and the median AS was 9/10. Preoperative daily heartburn, regurgitations, and respiratory complaints were improved in 95%, 95%, and 96% of patients, respectively. A total of 10% of the patients continued to use PPIs postoperatively. No significant difference was observed in terms of postoperative outcome or quality of life when comparing weakly acidic reflux patients with those diagnosed with preoperative acidic reflux. CONCLUSION Magnetic sphincter augmentation significantly improves GERD-related symptoms and quality of life in patients with weakly acidic reflux with very low postoperative morbidity.
Collapse
Affiliation(s)
- Milena Nikolic
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Aleksa Matic
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Joy Feka
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lisa Gensthaler
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ivan Kristo
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bogdan Osmokrovic
- Department of Trauma Surgery, Krankenhaus Oberwart, Dornburggasse 80, 7400, Oberwart, Austria
| | - Franz M Riegler
- Reflux Ordination, Mariannengasse 10/4/9, 1090, Vienna, Austria
| | - Berta O Mosleh
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sebastian F Schoppmann
- Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
|
8
|
Restoration for the foregut surgery: bridging gaps between foregut surgery practice and academia. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:175-179. [PMID: 35602858 PMCID: PMC8965975 DOI: 10.7602/jmis.2021.24.4.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023]
Abstract
Foregut surgery largely involves benign diseases, and not only malignant diseases. However, for foregut surgeons in Asia, this fact has not been extensively utilized in their clinical practice due to the high burden of gastric cancer surgery. Although the prevalence of gastroesophageal reflux disease (GERD) in Eastern Asia, including Korea, is increasing, antireflux surgery (ARS) is still a fairly rare procedure in Korea. ARS is effective as proton pump inhibitors and is cost-effective compared to continuous double-dose proton pump inhibitors in patients with severe GERD. Therefore, we should focus on ARS as a treatment option for GERD also in Asian population. Similarly, although bariatric/metabolic surgery is effective in weight reduction and diabetes mellitus (DM) remission in patients with morbid obesity or DM, bariatric/metabolic surgery is only performed in a limited number of patients. Given that the prevalence of obesity and DM is continuously increasing in Korea, bariatric/metabolic surgery should become an interest among Korean foregut surgeons and should be considered a treatment for obesity and DM. Furthermore, there are new surgical fields that can control both benign and malignant diseases. Oncometabolic surgery is a field under foregut surgery that treats both malignant and benign components of a condition, an example being the control of metabolic syndrome while performing gastric cancer surgery. Therefore, in future gastric cancer treatment, oncometabolic surgery can be applied to patients with gastric cancer accompanied by obesity or metabolic syndrome.
Collapse
|
|
9
|
Velanovich V. Practice-Changing Milestones in Anti-reflux and Hiatal Hernia Surgery: a Single Surgeon Perspective over 27 years and 1200 Operations. J Gastrointest Surg 2021; 25:2757-2769. [PMID: 33532979 DOI: 10.1007/s11605-021-04940-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND There have been steady innovations in hiatal hernia and anti-reflux surgery. The purpose of this article is to provide a historical perspective on practice-changing innovations in the context a single surgeon experience's over a career. METHODS Patients undergoing anti-reflux surgery or hiatal hernia repair by a single surgeon from 12/1992 to 3/2020 were reviewed. DATA COLLECTED sex, age, hiatal hernia type, operation type, adjuncts used, and additional procedure performed during index operation. Superimposed on this experience are the practice-changing innovations that occurred over this timeframe. RESULTS During the time period, 1200 operations were performed. Distributions: Hernia type: I, 707 (58.9%); II-IV, 325 (27.1%); Recurrent/Failed, 168 (14.0%). Type of operation, including laparoscopic and open: Nissen fundoplication: 889 (74.1%); Toupet fundoplication: 162 (13.5%); Collis-Nissen/Toupet fundoplication: 44 (3.7%); hiatal hernia repair without fundoplication (laparoscopic and open): 38 (3.2%); endoluminal fundoplication: 35 (2.9%); hiatal hernia repair with Heller myotomy/ Dor fundoplication: 10 (0.8%); transthoracic Belsey Mark IV: 2 (0.2%); hiatal hernia repair with magnetic sphincter augmentation: 20 (1.7%). Mesh reinforcement: 185 (15.4%). Additional procedures, 210 (17.5%). During this time, these practice-changing innovations occurred: laparoscopic surgery, 48-h pH monitoring, high-resolution manometry, tailoring of fundoplication, energy sources for tissue division and hemostasis, pyloroplasty for symptomatic gastroparesis, the rise and fall of endoluminal therapies, mesh reinforcement, abandonment of short gastric vessel division, and magnetic sphincter augmentation. CONCLUSIONS Over the last 27 years, a number of practice-changing advances have been made. These have led to changes in technique and operation selection of anti-reflux and hiatal hernia surgery.
Collapse
Affiliation(s)
- Vic Velanovich
- Division of General Surgery, The University of South Florida Morsani College of Medicine, 5 Tampa General Circle, Suite 740, Tampa, FL, 33606, USA.
| |
Collapse
|
|
10
|
Fass R, Boeckxstaens GE, El-Serag H, Rosen R, Sifrim D, Vaezi MF. Gastro-oesophageal reflux disease. Nat Rev Dis Primers 2021; 7:55. [PMID: 34326345 DOI: 10.1038/s41572-021-00287-w] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 02/07/2023]
Abstract
Gastro-oesophageal reflux disease (GERD) is a common disorder in adults and children. The global prevalence of GERD is high and increasing. Non-erosive reflux disease is the most common phenotype of GERD. Heartburn and regurgitation are considered classic symptoms but GERD may present with various atypical and extra-oesophageal manifestations. The pathophysiology of GERD is multifactorial and different mechanisms may result in GERD symptoms, including gastric composition and motility, anti-reflux barrier, refluxate characteristics, clearance mechanisms, mucosal integrity and symptom perception. In clinical practice, the diagnosis of GERD is commonly established on the basis of response to anti-reflux treatment; however, a more accurate diagnosis requires testing that includes upper gastrointestinal tract endoscopy and reflux monitoring. New techniques and new reflux testing parameters help to better phenotype the condition. In children, the diagnosis of GERD is primarily based on history and physical examination and treatment vary with age. Treatment in adults includes a combination of lifestyle modifications with pharmacological, endoscopic or surgical intervention. In refractory GERD, optimization of proton-pump inhibitor treatment should be attempted before a series of diagnostic tests to assess the patient's phenotype.
Collapse
Affiliation(s)
- Ronnie Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical System, Case Western Reserve University, Cleveland, OH, USA.
| | - Guy E Boeckxstaens
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Hashem El-Serag
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Royal London Hospital, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michael F Vaezi
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
|
11
|
Nikolic M, Matic A, Kristo I, Paireder M, Asari R, Osmokrovic B, Semmler G, Schoppmann SF. Additional fundophrenicopexia, after Nissen fundoplication, reduces postoperative dysphagia and re-operation rate in the long-term follow up. Surg Endosc 2021; 36:3019-3027. [PMID: 34159461 PMCID: PMC9001554 DOI: 10.1007/s00464-021-08598-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 06/06/2021] [Indexed: 01/19/2023]
Abstract
Background Various technical modifications of Nissen fundoplication (NF) that aim to improve patients’ outcomes have been discussed. This study aims to evaluate the effect of division of the short gastric vessels (SGV) and the addition of a standardized fundophrenicopexia on the postoperative outcome after NF. Methods 283 consecutive patients with GERD treated with NF were divided into four groups following consecutive time periods: with division of the SGV and without fundophrenicopexia (group A), with division of the SGV and with fundophrenicopexia (group B), without division of the SGV and with fundophrenicopexia (group C) and without division of the SGV and without fundophrenicopexia (group D). Postoperative contrast swallow, dysphagia scoring, GEDR-HRQL and proton pump inhibitor intake were evaluated. A comparative analysis of patients with division of the SGV and those without (161 A + B vs. 122 C + D), and patients with fundophrenicopexia and those without (78 A vs. 83 B and 49 C vs. 73 D) was performed. Results Fundophrenicopexia reduced postoperative dysphagia rates (0 group C vs. 5 group D, p = 0.021) in patients where the SGV were preserved and reoperation rates (1 group B vs. 7 group A, p = 0.017) in patients where the SGV were divided. There was no significant difference in the postoperative rates of heartburn relief, dysphagia, gas bloating syndrome, interventions, re-fundoplication and the GERD-HRQL score between groups A + B and C + D, respectively. Conclusion Standardized additional fundophrenicopexia in patients undergoing Nissen fundoplication significantly reduces postoperative dysphagia in patients without division of the SGV and reoperation rates in patients with division of the SGV. Division of the SGV has no influence on the postoperative outcome of NF.
Collapse
Affiliation(s)
- Milena Nikolic
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Aleksa Matic
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ivan Kristo
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Matthias Paireder
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reza Asari
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bogdan Osmokrovic
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Semmler
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Sebastian F Schoppmann
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
|
12
|
Park S, Kwon JW, Park JM, Park S, Seo KW. Treatment Pattern and Economic Burden of Refractory Gastroesophageal Reflux Disease Patients in Korea. J Neurogastroenterol Motil 2020; 26:281-288. [PMID: 31682754 PMCID: PMC7176495 DOI: 10.5056/jnm19050] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/12/2019] [Accepted: 07/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The prevalence of gastroesophageal reflux disease (GERD) has increased in Korea, and the economic burden of this chronic disease is substantial. We aim to investigate the treatment pattern and economic burden in Korea of refractory GERD requiring long-term use of proton pump inhibitors (PPIs). Methods We conducted a cross-sectional analysis of nationally representative sample data obtained from 2012 to 2016 and provided by the Health Insurance Review and Assessment Service. The participants were 86 936 in the medication group and 40 in the surgery group. Age- and sex-standardized prevalence of refractory GERD requiring PPIs medication for more than 12 weeks were analyzed. Generalized linear models were used to estimate cost ratios for comparing the medical costs of the surgery and medication groups after adjustment for demographics and comorbidity. Results The prevalence of refractory GERD increased from 1.2% in 2012 to 1.9% in 2016, and the estimated total number of GERD patients increased from 402 000 to 736 000 during this time period. The medical expenditures of the surgery group within 90 days of antireflux surgery (ARS) were 16.9-fold higher compared to those of the medication group; the significant difference in medical costs between the 2 groups disappeared after 90 days post-surgery. Conclusions The prevalence of refractory GERD requiring long-term use of PPIs has been trending upwards recently. Nevertheless, ARS is very rarely performed. Considering the increasing medical costs of long-term PPI use, further cost-effectiveness analysis is needed to compare ARS and PPI therapy for the treatment of GERD in Korea.
Collapse
Affiliation(s)
- Susan Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
| | - Jin-Won Kwon
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, Korea
| | - Joong-Min Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
|
13
|
Novel therapies for gastroesophageal reflux disease. Curr Probl Surg 2019; 56:100692. [PMID: 31837718 DOI: 10.1016/j.cpsurg.2019.100692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022]
|
|
14
|
Richards WO, Mcrae C. Comparative Analysis of Laparoscopic Fundoplication and Magnetic Sphincter Augmentation for the Treatment of Medically Refractory GERD. Am Surg 2018. [DOI: 10.1177/000313481808401132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We have recently introduced laparoscopic magnetic sphincter augmentation (MSA) combined with hiatal hernia repair for treatment of patients with medically refractory gastroesophageal reflux disease (GERD). MSA is a novel surgical approach to the treatment of severe GERD, in which magnetic beads are secured around the lower esophageal sphincter, augmenting the lower esophageal sphincter function as an anti-reflux barrier. We hypothesize that patients undergoing MSA will achieve GERD relief, equal to that obtained after laparoscopic Nissen fundoplication. The GERD Health Related Quality of Life (GERD HRQL) Questionnaire is a validated clinical tool that was used to quantify patient outcomes in terms of GERD-related symptoms both on and off proton pump inhibitors and after acute radiation syndrome. We retrospectively reviewed data from patients at our institution enrolled in a prospective institutional review board–approved database “Registry Outcomes Anti-Reflux Surgery” that applies objective and subjective information about patients undergoing anti-reflux surgery. Information from both the database and patient HRQL scores were used to compare the effectiveness of medical intervention with acute radiation syndrome (laparoscopic Nissen fundoplication and MSA) in decreasing GERD-related symptoms in patients. Results are expressed as mean ± SE, and single-factor ANOVA test was used to compare groups. We found that MSA and laparoscopic fundoplication both lead to a comparable decrease in HRQL score and an increase in patient satisfaction when compared with patient's preoperative symptoms with maximum proton pump inhibitor use. In addition, our study shows that MSA is a safe minimally invasive anti-reflux procedure without the negative side-effects, such as gas bloat, inability to belch, and inability to vomit, commonly associated with NF.
Collapse
Affiliation(s)
- William O. Richards
- Department of Surgery, University of South Alabama Health System, Mobile, Alabama
| | - Carly Mcrae
- Department of Surgery, University of South Alabama Health System, Mobile, Alabama
| |
Collapse
|
|
15
|
Lee TG, Lee IS, Kim BS, Jung HY, Choi YB. Surgical outcomes and over one-year follow-up results of laparoscopic Nissen fundoplication for gastroesophageal reflux disease: Single-center experiences. Asian J Surg 2018; 42:557-562. [PMID: 30316665 DOI: 10.1016/j.asjsur.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Laparoscopic antireflux surgery is a standard surgical treatment method for gastroesophageal reflux disease (GERD) in Western countries. However, the procedure has not been actively carried out in Korea because of concerns regarding surgical complications. Here, we conducted this study to evaluate short-term surgical outcomes of laparoscopic Nissen fundoplication (LNF) performed at a single institution. METHODS From January 2010 to August 2016, totally 29 patients underwent LNF for GERD performed by three surgeons at Asan Medical Center, Korea. All patients participated in a telephonic survey including the presence of symptoms and the status of quality of life (QOL). RESULTS The median age at operation and BMI were 54 years and 23.8 kg/m2, respectively. Preoperatively, 27 patients (93.1%) underwent PPI therapy. All patients had typical or atypical GERD symptoms. One patient (3.4%) required reoperation because of total gastroesophageal junction obstruction. 24 patients (82.8%) reported complete or partial resolution of symptoms, whereas 21 (72.4%) reported partial or complete improvement in quality of life. In patients with reflux esophagitis, GERD symptoms were significantly relieved after LNF (P = 0.005). LNF responders tended to perceive an improvement in quality of life post operation (P < 0.001). CONCLUSION LNF is a feasible, safe, and effective treatment option for controlling GERD symptoms as well as improving the quality of life. Presence of reflux esophagitis was a predictor of successful outcomes.
Collapse
Affiliation(s)
- Tae-Gyun Lee
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - In-Seob Lee
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea.
| | - Beom-Su Kim
- Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Youn-Baik Choi
- Department of Surgery, Chung Hospital, Seoul, South Korea
| |
Collapse
|
|
16
|
Schlottmann F, Strassle PD, Patti MG. Antireflux Surgery in the USA: Influence of Surgical Volume on Perioperative Outcomes and Costs-Time for Centralization? World J Surg 2018; 42:2183-2189. [PMID: 29288311 DOI: 10.1007/s00268-017-4429-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Few studies have analyzed the relationship between surgical volume and outcomes after antireflux procedures. The aim of this study was to determine the effect of surgical volume on postoperative results and costs for patients undergoing surgery for gastroesophageal reflux disease. METHODS We analyzed the National Inpatient Sample (period 2000-2013). Adult patients (≥18 years old) with gastroesophageal reflux disease who underwent fundoplication were included. Hospital surgical volume was determined using the 30th and 60th percentile cut points using weighted discharges and categorized as low (<10 operations/year), intermediate (10-25 operations/year), or high (>25 operations/year). We performed multivariable logistic regression models to assess the effect of surgical volume on patient outcomes. RESULTS The studied cohort comprised 75,544 patients who had antireflux surgery. When operations performed at low-volume hospitals, postoperative bleeding, cardiac failure, renal failure, respiratory failure, and inpatient mortality were more common. In intermediate-volume hospitals, patients were more likely to have postoperative infection, esophageal perforation, bleeding, cardiac failure, renal failure, and respiratory failure. The length of hospital stay was longer at low- and intermediate-volume hospitals (1.08 and 0.55 days longer, respectively). There was an increase in charges of 5120 dollars per patient at low-volume centers, and 4010 dollars per patient at intermediate-volume centers. CONCLUSIONS When antireflux surgery is performed at high-volume hospitals, morbidity is lower, length of hospital stay is shorter, and costs for the healthcare system are decreased.
Collapse
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco G Patti
- Department of Medicine and Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
|
17
|
Zadeh J, Andreoni A, Treitl D, Ben-David K. Spotlight on the Linx™ Reflux Management System for the treatment of gastroesophageal reflux disease: evidence and research. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2018; 11:291-300. [PMID: 30214323 PMCID: PMC6124788 DOI: 10.2147/mder.s113679] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The initial approach to gastroesophageal reflux disease (GERD) management typically involves lifestyle modification and medical therapy utilizing acid reducing agents such as histamine blockers and proton pump inhibitors. In severe cases refractory to such treatments, surgical therapy may be indicated. The gold standard for surgical treatment of GERD is the laparoscopic Nissen fundoplication. In recent years, a new technique known as magnetic sphincter augmentation (MSA) has been developed using the Linx™ Reflux Management System. This is an implantable ring of magnetic beads that is placed around the esophagus at the gastroesophageal junction to restore lower esophageal integrity. The aim of this review is to discuss the current literature regarding indications, surgical technique, efficacy, and complications of MSA using the Linx device. METHODS A standardized literature search was performed yielding 367 abstracts. After elimination due to duplicates between databases and irrelevance, 96 articles remained. The information found to be significant and non-redundant was included in this review. CONCLUSION After several years of clinical application, the Linx device has been shown to not only be effective for the management of GERD but also be as effective as fundoplication. With respect to safety, the most common complication of MSA is dysphagia. This often resolved without intervention, but esophageal dilation or device explanation are occasionally necessary. Not fully appreciated in earlier reviews, erosion of the device into the esophagus appears to be the most significant complication of the device after extended follow-up. While very rare, the potentially severe consequences of this phenomenon suggest that the device should be used with some restraint and that patients should be made aware of this potential morbidity. Fortunately, in the few cases of device erosion described in the literature reviewed, the Linx device was easily and safely removed.
Collapse
Affiliation(s)
- Jonathan Zadeh
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
| | - Anthony Andreoni
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
| | - Daniela Treitl
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
| | - Kfir Ben-David
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA,
| |
Collapse
|
|
18
|
DEL GRANDE LM, HERBELLA FAM, KATAYAMA RC, SCHLOTTMANN F, PATTI MG. THE ROLE OF THE TRANSDIAPHRAGMATIC PRESSURE GRADIENT IN THE PATHOPHYSIOLOGY OF GASTROESOPHAGEAL REFLUX DISEASE. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55Suppl 1:13-17. [DOI: 10.1590/s0004-2803.201800000-39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 12/15/2022]
Abstract
ABSTRACT Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract in the Western world. GERD pathophysiology is multifactorial. Different mechanisms may contribute to GERD including an increase in the transdiaphragmatic pressure gradient (TPG). The pathophysiology of GERD linked to TPG is not entirely understood. This review shows that TPG is an important contributor to GERD even when an intact esophagogastric barrier is present in the setting of obesity and pulmonary diseases.
Collapse
|
|
19
|
Yadlapati R, Hungness ES, Pandolfino JE. Complications of Antireflux Surgery. Am J Gastroenterol 2018; 113:1137-1147. [PMID: 29899438 PMCID: PMC6394217 DOI: 10.1038/s41395-018-0115-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
Abstract
Antireflux surgery anatomically restores the antireflux barrier and is a therapeutic option for proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease or PPI intolerance. Laparoscopic fundoplication is the standard antireflux surgery, though its popularity has declined due to concerns regarding wrap durability and adverse events. As the esophagogastric junction is an anatomically complex and dynamic area subject to mechanical stress, wraps are susceptible to disruption, herniation or slippage. Additionally, recreating an antireflux barrier to balance bidirectional bolus flow is challenging, and wraps may be too tight or too loose. Given these complexities it is not surprising that post-fundoplication symptoms and complications are common. Perioperative mortality rates range from 0.1 to 0.2% and prolonged structural complications occur in up to 30% of cases. Upper gastrointestinal endoscopy with a comprehensive retroflexed examination of the fundoplication and barium esophagram are the primary tests to assess for structural complications. Management hinges on differentiating complications that can be managed with medical and lifestyle optimization versus those that require surgical revision. Reoperation is best reserved for severe structural abnormalities and troublesome symptoms despite medical and endoscopic therapy given its increased morbidity and mortality. Though further data are needed, magnetic sphincter augmentation may be a safer alternative to fundoplication.
Collapse
Affiliation(s)
- Rena Yadlapati
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | |
Collapse
|
|
20
|
Schlottmann F, Strassle PD, Patti MG. Surgery for benign esophageal disorders in the US: risk factors for complications and trends of morbidity. Surg Endosc 2018; 32:3675-3682. [PMID: 29435748 DOI: 10.1007/s00464-018-6102-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/07/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD), paraesophageal hernia (PEH), and achalasia are the most frequent benign esophageal disorders that may need surgical treatment. We aimed to identify risk factors for postoperative complications and to characterize trends of morbidity for surgery for benign esophageal disorders in a national cohort. METHODS A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000-2013. Adult patients (≥ 18 years old) diagnosed with GERD, PEH, and achalasia, and who underwent fundoplication, PEH repair, and esophagomyotomy were included. The yearly incidence of complications, stratified by procedure, was calculated using Poisson regression, and multivariable logistic regression was used to determine risk factors for complications. RESULTS A total of 79,622 patients were included; 38,695 (48.6%) underwent PEH repair, 38,719 (48.6%) fundoplication, and 2208 (2.8%) esophagomyotomy. While the rate of postoperative complications dropped from 26.5 to 10.0% and from 16.1 to 12.2% for PEH repair and esophagomyotomy, respectively, the complication rate after fundoplication increased from 5.7 to 12.7% during the same period (p < 0.0001). Age, black race, diabetes, renal insufficiency, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, and open surgery were independent risk factors for postoperative complications. The rate of laparoscopic procedures for PEH repair increased from 4.9 to 91.4%, while for fundoplication it increased from 24.2 to 78.3% (p < 0.0001). CONCLUSIONS Opposite to PEH repair and esophagomyotomy, antireflux surgery has shown an increase in the morbidity rate in the last decade. Patient selection and embracement of laparoscopic techniques are critical to improve the perioperative outcome in surgery for benign esophageal disorders.
Collapse
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA. .,Department of Surgery, Hospital Alemán of Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina.
| | - Paula D Strassle
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco G Patti
- Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
|
21
|
Ganz RA. A Modern Magnetic Implant for Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol 2017; 15:1326-1337. [PMID: 28025156 DOI: 10.1016/j.cgh.2016.12.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/18/2016] [Accepted: 12/14/2016] [Indexed: 02/07/2023]
Abstract
A magnetic implant for the treatment of gastroesophageal reflux disease (GERD) was Food and Drug Administration-approved in 2012 and has been extensively evaluated. The device is a ring of magnets that are placed around the gastroesophageal junction, augmenting the native lower esophageal sphincter and preventing reflux yet preserving lower esophageal sphincter physiologic function and allowing belching and vomiting. Magnetic force is advantageous, being permanent and precise, and forces between magnets decrease with esophageal displacement. Multiple patient cohorts have been studied using the magnetic device, and trials establish consistent, long-term improvement in pH data, GERD symptom scores, and proton-pump inhibitor use. A 5-year Food and Drug Administration trial demonstrated that most patients achieved normal pH scores, 85% stopped proton-pump inhibitors, and GERD health-related quality of life symptom scores improved from 27 to 4 at 5 years. Seven studies have compared magnetic augmentation with laparoscopic Nissen fundoplication and demonstrated that the magnetic device achieved comparable efficacy with regard to proton-pump inhibitor cessation, GERD symptom score improvement, and heartburn and regurgitation scores. However, to date there have been no randomized, controlled trials comparing the 2 techniques, and the study cohorts are not necessarily comparable regarding hiatal hernia size, severity of reflux, body mass index scores, or esophagitis scores. Dysphagia incidence was similar in both groups. Reoperation rates and safety profiles were also comparable, but the magnetic device demonstrated significant beneficial differences in allowing belching and vomiting. The magnetic device is safe, with the main adverse event being dysphagia with an approximate 3%-5% chronic incidence. Device removals in clinical trials have been between 0% and 7% and were uneventful. There have been no erosions, perforations, or infections in FDA clinical trials; erosions have rarely been noted in practice. Magnetic augmentation of the lower esophageal sphincter is a safe and effective operation for GERD, and should be considered a surgical option for those seeking a fundic-sparing operation, particularly those with parameters consistent with study cohorts. Additional randomized, controlled trials are underway.
Collapse
Affiliation(s)
- Robert A Ganz
- Minnesota Gastroenterology, PA, Plymouth, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Abbott-Northwestern Hospital, Minneapolis, Minnesota.
| |
Collapse
|
|
22
|
SAGES technology and value assessment committee (TAVAC) safety and effectiveness analysis: LINX ® reflux management system. Surg Endosc 2017; 31:3811-3826. [PMID: 28842765 DOI: 10.1007/s00464-017-5813-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
|
|
23
|
|
|
24
|
Schlottmann F, Strassle PD, Patti MG. Comparative Analysis of Perioperative Outcomes and Costs Between Laparoscopic and Open Antireflux Surgery. J Am Coll Surg 2017; 224:327-333. [PMID: 28132820 DOI: 10.1016/j.jamcollsurg.2016.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Laparoscopic antireflux surgery (LARS) has proven to be as effective as open antireflux surgery (OARS), but it is associated with a shorter hospital stay and a faster recover. The aims of this study were to assess the national use of LARS in the US and to compare the perioperative outcomes between laparoscopic and open antireflux procedures in a national cohort. STUDY DESIGN A retrospective population-based analysis was performed using the National Inpatient Sample for the period 2000 to 2013. The study included adult patients (18 years and older) diagnosed with gastroesophageal reflux disease (GERD), who underwent either laparoscopic or open fundoplication. Multivariable linear and logistic regression, adjusted for patient demographics, comorbidities, and hospital characteristics were used to assess the effect of the laparoscopic approach on patient outcomes. RESULTS A total of 75,544 patients were included, with 44,089 having LARS (58.4%) and 31,455 having OARS (41.6%). The rate of laparoscopic procedures increased from 24.8 LARS per 100 procedures in 2000, to 84.3 LARS per 100 procedures in 2013 (p < 0.0001). Patients undergoing laparoscopic surgery were less likely to experience postoperative venous thromboembolism, wound complications, infection, esophageal perforation, bleeding, cardiac failure, renal failure, respiratory failure, shock, and inpatient mortality. On average, the laparoscopic approach reduced length of stay by 2.1 days, and decreased hospital charges by $9,530. CONCLUSIONS The use of the laparoscopic approach for the surgical treatment of GERD has increased significantly in the last decade in the US. This approach is associated with lower morbidity and mortality, shorter hospital stay, and lower costs for the health care system.
Collapse
Affiliation(s)
- Francisco Schlottmann
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Paula D Strassle
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marco G Patti
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC; Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
|
25
|
Rodríguez L, Rodriguez PA, Gómez B, Netto MG, Crowell MD, Soffer E. Electrical stimulation therapy of the lower esophageal sphincter is successful in treating GERD: long-term 3-year results. Surg Endosc 2016; 30:2666-72. [PMID: 26487200 PMCID: PMC4912595 DOI: 10.1007/s00464-015-4539-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/01/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Electrical stimulation of the lower esophageal sphincter (LES) has been shown to improve outcomes in patients with gastroesophageal reflux disease (GERD) at 2 years. The aim of the study was to evaluate the safety and efficacy of LES stimulation in the same cohort at 3 years. METHODS GERD patients with partial response to PPI, with % 24-h esophageal pH < 4.0 for >5 %, with hiatal hernia <3 cm and with esophagitis ≤LA grade C were treated with LES stimulation in an open-label 2-year trial. All patients were on fixed stimulation parameter of 20 Hz, 220 μs, 5 mA delivered in twelve, 30-min sessions. After completing the 2-year open-label study, they were offered enrollment into a multicenter registry trial and were evaluated using GERD-HRQL, symptom diaries and pH testing at their 3-year follow-up. RESULTS Fifteen patients completed their 3-year evaluation [mean (SD) age = 56.1 (9.7) years; men = 8] on LES stimulation. At 3 years, there was a significant improvement in their median (IQR) GERD-HRQL on electrical stimulation compared to both their on PPI [9 (6-10) vs. 1 (0-2), p = 0.001] and off PPI [22 (21-24) vs. 1 (0-2), p < 0.001]. Median 24-h distal esophageal acid exposure was significantly reduced from [10.3 (7.5-11.6) % at baseline vs. 3 (1.9-4.5) %, p < 0.001] at 3 years. Seventy-three % (11/15) patients had normalized their distal esophageal acid exposure at 3 years. Remaining four patients had improved their distal esophageal acid exposure by 39-48 % from baseline. All but four patients reported cessation of regular PPI use (>50 % of days with PPI use); three had normal esophageal pH at 3 years. There were no unanticipated device- or stimulation-related adverse events or untoward sensation reported during the 2- to 3-year follow-up. CONCLUSION LES-EST is safe and effective for treating patients with GERD over long-term, 3-year duration. There was a significant and sustained improvement in esophageal acid exposure and reduction in GERD symptoms and PPI use. Further, no new GI side effects or adverse events were reported.
Collapse
Affiliation(s)
| | | | - Beatrice Gómez
- Centro Clinico de Obesidad Diabetes y Reflujo, Santiago, Chile
| | | | | | - Edy Soffer
- Department of Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
|
26
|
Hashimi S, Bremner RM. Complications Following Surgery for Gastroesophageal Reflux Disease and Achalasia. Thorac Surg Clin 2016; 25:485-98. [PMID: 26515948 DOI: 10.1016/j.thorsurg.2015.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical procedures to treat reflux disease are common, but good outcomes rely on both a thorough preoperative workup and careful surgical techniques. Although complications are uncommon, surgeons should recognize these and possess the skills to overcome them in clinical practice.
Collapse
Affiliation(s)
- Samad Hashimi
- Department of Thoracic Disease and Transplantation, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Suite 500, Phoenix, AZ 85013, USA
| | - Ross M Bremner
- Department of Thoracic Disease and Transplantation, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Suite 500, Phoenix, AZ 85013, USA.
| |
Collapse
|
|
27
|
Khan F, Maradey-Romero C, Ganocy S, Frazier R, Fass R. Utilisation of surgical fundoplication for patients with gastro-oesophageal reflux disease in the USA has declined rapidly between 2009 and 2013. Aliment Pharmacol Ther 2016; 43:1124-31. [PMID: 27060607 DOI: 10.1111/apt.13611] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/06/2016] [Accepted: 03/13/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Surgical fundoplication has been considered to be one of the leading therapeutic modalities for gastro-oesophageal reflux disease (GERD) during the last several decades. AIM To determine the trend of surgical fundoplication utilisation in GERD patients during the last decade in the United States. METHODS Population-based study using a large nationwide database, the Explorys database system, to identify patients diagnosed with GERD and those who underwent surgical fundoplication. Using a quadratic regression model, we determined and compared the trends of surgical fundoplication utilisation annually from 2004 to 2013. RESULTS We identified 4 059 060 patients with the diagnosis of GERD, of whom 2343 (0.05%) underwent surgical fundoplication between 2004 and 2013. There was a significant decline in the number of surgical fundoplications performed over the last 5 years from 0.062% in 2009 to 0.047% in 2013 (P < 0.05). Female patients accounted for the majority of those who underwent fundoplication (62.52%). Caucasian patients between the ages of 18 and 65 years were the most likely group to undergo surgical fundoplication (66.28%). The number of overweight patients undergoing surgical fundoplication has been significantly increasing over the last decade (P < 0.05). Importantly, 80% of surgical patients were treated with a proton pump inhibitor (PPI) post surgical fundoplication by 2013 (P < 0.001). CONCLUSIONS Utilisation of surgical fundoplication in GERD patients has been steadily declining over the past 5 years. The vast majority of patients will resume PPI treatment after surgical fundoplication.
Collapse
Affiliation(s)
- F Khan
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - C Maradey-Romero
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - S Ganocy
- Center Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
| | - R Frazier
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - R Fass
- The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
|
28
|
Effect of Vagus Nerve Integrity on Short and Long-Term Efficacy of Antireflux Surgery. Am J Gastroenterol 2016; 111:508-15. [PMID: 26977759 DOI: 10.1038/ajg.2016.42] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/24/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Vagus nerve injury is a feared complication of antireflux surgery (ARS) that may negatively affect reflux control. The aim of the present prospective study was to evaluate short-term and long-term impact of vagus nerve injury, evaluated by pancreatic polypeptide response to insulin-induced hypoglycemia (PP-IH), on the outcome of ARS. METHODS In the period from 1990 until 2000, 125 patients with gastroesophageal reflux disease (GERD) underwent ARS at a single center. Before and 6 months after surgery, vagus nerve integrity testing (PP-IH), 24-h pH-monitoring, gastric emptying, and reflux-associated symptoms were evaluated. In 2014, 14-25 years after surgery, 110 patients were contacted again for evaluation of long-term symptomatic outcome using two validated questionnaires (Gastrointestinal Symptom Rating Scale (GSRS) and GERD-Health Related Quality of Life (HRQL)). RESULTS Short-term follow-up: vagus nerve injury (PP peak ≤47 pmol/l) was observed in 23 patients (18%) 6 months after fundoplication. In both groups, a comparable decrease in reflux parameters and symptoms was observed at 6-month follow-up. Postoperative gastric emptying was significantly delayed in the vagus nerve injury group compared with the vagus nerve intact group. Long-term follow-up: patients with vagus nerve injury showed significantly less effective reflux control and a higher re-operation rate. CONCLUSIONS Vagus nerve injury occurs in up to 20% of patients after ARS. Reflux control 6 months after surgery was not affected by vagus nerve injury. However, long-term follow-up showed a negative effect on reflux symptom control and re-operation rate in patients with vagus nerve injury.
Collapse
|
|
29
|
Tatarian T, Pucci MJ, Palazzo F. A Modern Approach to the Surgical Treatment of Gastroesophageal Reflux Disease. J Laparoendosc Adv Surg Tech A 2016; 26:174-9. [DOI: 10.1089/lap.2015.0530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Talar Tatarian
- The Jefferson Gastroesophageal Center, Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michael J. Pucci
- The Jefferson Gastroesophageal Center, Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Francesco Palazzo
- The Jefferson Gastroesophageal Center, Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
|
30
|
Soffer E, Rodríguez L, Rodriguez P, Gómez B, Neto MG, Crowell MD. Effect of electrical stimulation of the lower esophageal sphincter in gastroesophageal reflux disease patients refractory to proton pump inhibitors. World J Gastrointest Pharmacol Ther 2016; 7:145-155. [PMID: 26855821 PMCID: PMC4734948 DOI: 10.4292/wjgpt.v7.i1.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/09/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of lower esophageal sphincter (LES)-electrical stimulation therapy (EST) in a subgroup of patients that reported only partial response to proton pump inhibitors (PPIs) therapy, compared to a group of patient with complete response.
METHODS: Bipolar stitch electrodes were laparoscopically placed in the LES and connected to an implantable pulse generator (EndoStim BV, the Hague, the Netherlands), placed subcutaneously in the anterior abdominal wall. Stimulation at 20 Hz, 215 μsec, 3-8 mAmp in 30 min sessions was delivered starting on day 1 post-implant. Patients were evaluated using gastroesophageal reflux disease (GERD)-HRQL, symptom diaries; esophageal pH and esophageal manometry before and up to 24 mo after therapy and results were compared between partial and complete responders.
RESULTS: Twenty-three patients with GERD on LES-EST were enrolled and received continuous per-protocol stimulation through 12 mo and 21 patients completed 24 mo of therapy. Of the 23 patients, 16 (8 male, mean age 52.1 ± 12 years) had incomplete response to PPIs prior to LES-EST, while 7 patients (5 male, mean age 52.7 ± 4.7) had complete response to PPIs. In the sub-group with incomplete response to PPIs, median (IQR) composite GERD-HRQL score improved significantly from 9.5 (9.0-10.0) at baseline on-PPI and 24.0 (20.8-26.3) at baseline off-PPI to 2.5 (0.0-4.0) at 12-mo and 0.0 (0.0-2.5) at 24-mo follow-up (P < 0.05 compared to on-and off-PPI at baseline). Median (IQR) % 24-h esophageal pH < 4.0 at baseline in this sub-group improved significantly from 9.8% (7.8-11.5) at baseline to 3.0% (1.9-6.3) at 12 mo (P < 0.001) and 4.6% (2.0-5.8) at 24 mo follow-up (P < 0.01). At their 24-mo follow-up, 9/11 patients in this sub-group were completely free of PPI use. These results were comparable to the sub-group that reported complete response to PPI therapy at baseline. No unanticipated implantation or stimulation-related adverse events, or any untoward sensation due to stimulation were reported in either group and LES-EST was safely tolerated by both groups.
CONCLUSION: LES-EST is safe and effective in controlling symptoms and esophageal acid exposure in GERD patients with incomplete response to PPIs. These results were comparable to those observed PPI responders.
Collapse
|
|
31
|
Abstract
Patients with gastroesophageal reflux disease (GERD) who are not satisfied with acid suppression therapy can benefit primarily from fundoplication, a surgical intervention. Fundoplication has been the standard surgical procedure for GERD. It is effective but is associated with adverse effects, resulting in a declining number of interventions, creating a need for alternative interventions that are effective, yet have a better adverse effect profile. One such alternative involves the application of electrical stimulation to the lower esophageal sphincter. A number of animal studies showed that such stimulation can increase resting lower esophageal sphincter pressure. An acute human study confirmed this effect, and was followed by two open-label studies, with a follow-up of up to 3 years. Results thus far show that the therapy is associated with a significant improvement in symptoms, a significant reduction in esophageal acid exposure, and a very good safety profile. This review will describe the evolution of electrical stimulation therapy for GERD, as well as the safety and efficacy of this intervention.
Collapse
Affiliation(s)
- Sharon E Kim
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Edy Soffer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
|
32
|
Warren HF, Reynolds JL, Lipham JC, Zehetner J, Bildzukewicz NA, Taiganides PA, Mickley J, Aye RW, Farivar AS, Louie BE. Multi-institutional outcomes using magnetic sphincter augmentation versus Nissen fundoplication for chronic gastroesophageal reflux disease. Surg Endosc 2015; 30:3289-96. [PMID: 26541740 DOI: 10.1007/s00464-015-4659-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 10/28/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Magnetic sphincter augmentation (MSA) has emerged as an alternative surgical treatment of gastroesophageal reflux disease (GERD). The safety and efficacy of MSA has been previously demonstrated, although adequate comparison to Nissen fundoplication (NF) is lacking, and required to validate the role of MSA in GERD management. METHODS A multi-institutional retrospective cohort study of patients with GERD undergoing either MSA or NF. Comparisons were made at 1 year for the overall group and for a propensity-matched group. RESULTS A total of 415 patients (201 MSA and 214 NF) underwent surgery. The groups were similar in age, gender, and GERD-HRQL scores but significantly different in preoperative obesity (32 vs. 40 %), dysphagia (27 vs. 39 %), DeMeester scores (34 vs. 39), presence of microscopic Barrett's (18 vs. 31 %) and hiatal hernia (55 vs. 69 %). At a minimum of 1-year follow-up, 354 patients (169 MSA and 185 NF) had significant improvement in GERD-HRQL scores (pre to post: 21-3 and 19-4). MSA patients had greater ability to belch (96 vs. 69 %) and vomit (95 vs. 43 %) with less gas bloat (47 vs. 59 %). Propensity-matched cases showed similar GERD-HRQL scores and the differences in ability to belch or vomit, and gas bloat persisted in favor of MSA. Mild dysphagia was higher for MSA (44 vs. 32 %). Resumption of daily PPIs was higher for MSA (24 vs. 12, p = 0.02) with similar patient-reported satisfaction rates. CONCLUSIONS MSA for uncomplicated GERD achieves similar improvements in quality of life and symptomatic relief, with fewer side effects, but lower PPI elimination rates when compared to propensity-matched NF cases. In appropriate candidates, MSA is a valid alternative surgical treatment for GERD management.
Collapse
Affiliation(s)
- Heather F Warren
- Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street Suite 900, Seattle, WA, 98104, USA
| | - Jessica L Reynolds
- Division of Upper GI and General Surgery, Keck Medical Center at University of Southern California, Los Angeles, CA, USA
| | - John C Lipham
- Division of Upper GI and General Surgery, Keck Medical Center at University of Southern California, Los Angeles, CA, USA
| | - Joerg Zehetner
- Division of Upper GI and General Surgery, Keck Medical Center at University of Southern California, Los Angeles, CA, USA
| | - Nikolai A Bildzukewicz
- Division of Upper GI and General Surgery, Keck Medical Center at University of Southern California, Los Angeles, CA, USA
| | | | | | - Ralph W Aye
- Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street Suite 900, Seattle, WA, 98104, USA
| | - Alexander S Farivar
- Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street Suite 900, Seattle, WA, 98104, USA
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, 1101 Madison Street Suite 900, Seattle, WA, 98104, USA.
| |
Collapse
|
|
33
|
Palvannan P, Miranda I, Merchant AM. The combined effect of age and body mass index on outcomes in foregut surgery: a regression model analysis of the National Surgical Quality Improvement Program data. Surg Endosc 2015; 30:2572-82. [PMID: 26377066 DOI: 10.1007/s00464-015-4529-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/21/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND In a parallel demographic phenomenon, the elderly and obese populations will become a larger part of our population and surgical practices. The elderly obese surgical risk profile is not clearly defined, although studies have confirmed their independent negative effect on surgical outcomes. Benign foregut surgery is a relatively common complex procedure performed on this demographic and warrants deeper investigation into outcomes. We investigate the synergistic effect of age and body mass index (BMI) on the outcomes of benign foregut surgery. METHODS Data from National Surgical Quality Improvement Program were collected for all patients undergoing foregut surgery from 2005 to 2012. Subjects were over 18 years of age and 16 BMI. Primary and secondary outcomes were 30-day mortality and overall 30-day morbidity, respectfully. Binary logistic regression models were used to assess independent and interactive effects of age and BMI. RESULTS A total of 19,547 patients had an average age and BMI of 57 and 29.7, respectively. Sample 30-day mortality was 0.32 %. Every 10-year age increase led to a 46 % increased odds of mortality. BMI showed a bimodal distribution with underweight and morbidly obese patients having increased mortality. The effect of BMI only became apparent with increasing age. CONCLUSIONS Both age and BMI are independent predictors of mortality; only older patients experienced the bimodal BMI effect. Therefore, increasing age and BMI have a synergistic effect on outcomes after foregut operations.
Collapse
Affiliation(s)
- Prashanth Palvannan
- School of Public Health, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ, USA
| | - Irving Miranda
- Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, 07103, USA
| | - Aziz M Merchant
- Department of Surgery, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, 185 South Orange Avenue, Suite MSB G530, Newark, NJ, 07103, USA.
| |
Collapse
|
|
34
|
Kappelle WFW, Bredenoord AJ, Conchillo JM, Ruurda JP, Bouvy ND, van Berge Henegouwen MI, Chiu PW, Booth M, Hani A, Reddy DN, Bogte A, Smout AJPM, Wu JC, Escalona A, Valdovinos MA, Torres-Villalobos G, Siersema PD. Electrical stimulation therapy of the lower oesophageal sphincter for refractory gastro-oesophageal reflux disease - interim results of an international multicentre trial. Aliment Pharmacol Ther 2015; 42:614-25. [PMID: 26153531 DOI: 10.1111/apt.13306] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/06/2015] [Accepted: 06/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND A previous single-centre study showed that lower oesophageal sphincter electrical stimulation therapy (LES-EST) in gastro-oesophageal reflux disease (GERD) patients improves reflux symptoms and decreases oesophageal acid exposure. AIM To evaluate safety and efficacy of LES-EST in GERD patients with incomplete response to proton pump inhibitors (PPIs) in a prospective, international, multicentre, open-label study. METHODS GERD patients, partially responsive to PPIs, received LES-EST. GERD health-related quality of life (GERD-HRQL), daily symptom diaries, quality of life scores, oesophageal acid exposure, and LES resting and residual pressure were measured before and after initiation of LES-EST. Stimulation sessions were optimised based on residual symptoms and oesophageal acid exposure. RESULTS Forty-four patients were enrolled and 6-month data from 41 patients are available. Hiatal repair was performed in 16 patients. One device-related, one procedure-related and one unrelated severe adverse event were reported. GERD-HRQL improved from 31.0 (IQR 26.2-36.8) off-PPI and 16.5 (IQR 9.0-22.8) on-PPI to 4 (IQR 1-8) at 3-month and 5 (IQR 3-9) at 6-month follow-up (P < 0.0001 vs. on- and off-PPI). Oesophageal acid exposure (pH < 4.0) improved from 10.0% (IQR 7.5-12.9) to 3.8% (IQR 1.9-12.3) at 3 months (P = 0.0027) and 4.4% (IQR 2.2-7.2) at 6 months (P < 0.0001). CONCLUSIONS These interim results show an acceptable safety record of LES-EST to date, combined with good short-term efficacy in GERD patients who are partially responsive to PPI therapy. A remarkable reduction in regurgitation symptoms, without the risk of intervention-requiring dysphagia may prove to be an advantage compared with other anti-reflux procedures. ClinicalTrials.gov Identifier: NCT01574339.
Collapse
Affiliation(s)
- W F W Kappelle
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - J M Conchillo
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - J P Ruurda
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - N D Bouvy
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - P W Chiu
- Chinese University of Hong Kong, Hong Kong
| | - M Booth
- Waitemata Specialist Centre, Auckland, The New Zealand
| | - A Hani
- Pontificia Universidad Javeriana - Hospital San Ignacio, Bogota, Colombia
| | - D N Reddy
- Asian Institute of Gastroenterology, Hyderabad, India
| | - A Bogte
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - J C Wu
- Chinese University of Hong Kong, Hong Kong
| | - A Escalona
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - M A Valdovinos
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - G Torres-Villalobos
- Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - P D Siersema
- University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
|
35
|
Abstract
There are limited options to patients with gastroesophageal reflux disease (GERD) who are not satisfied with acid suppression therapy. Fundoplication, the standard surgical procedure for GERD, is effective but is associated with adverse side effects and has thus been performed less frequently, creating a need for alternative surgical interventions that are effective, yet less invasive and reversible. Lately, two such interventions were developed: the magnetic sphincter augmentation and electrical stimulation of the lower esophageal sphincter. Human studies describing safety and efficacy over a follow-up period of a number of years have been published, documenting efficacy and safety of these interventions. Future studies should clarify the role of these procedures in the spectrum of GERD therapy.
Collapse
Affiliation(s)
- Jenny Chiu
- Department of Medicine, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Los Angeles, CA 90033, USA
| | | |
Collapse
|
|
36
|
Nadaleto BF, Herbella FAM, Patti MG. Gastroesophageal reflux disease in the obese: Pathophysiology and treatment. Surgery 2015; 159:475-86. [PMID: 26054318 DOI: 10.1016/j.surg.2015.04.034] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/07/2015] [Accepted: 04/28/2015] [Indexed: 12/12/2022]
Abstract
Obesity is a condition that has increased all over the world in the last 3 decades. Overweight and gastroesophageal reflux disease (GERD) are related. GERD may have different causative factors in the obese compared with lean individuals. This review focuses on the proper treatment for GERD in the obese based on its pathophysiology. Increased abdominal pressure may play a more significant role in obese subjects with GERD than the defective esophagogastric barrier usually found in nonobese individuals. A fundoplication may be used to treat GERD in these individuals; however, outcomes may be not as good as in nonobese patients and it does not act on the pathophysiology of the disease. All bariatric techniques may ameliorate GERD symptoms owing to a decrease in abdominal pressure secondary to weight loss. However, some operations may lead to a disruption of natural anatomic antireflux mechanisms or even lead to slow gastric emptying and/or esophageal clearance and thus be a refluxogenic procedure. Roux-en-Y gastric bypass decreases both acid and bile reflux from the stomach into the esophagus. On the other hand, gastric banding is a refluxogenic operation, and sleeve gastrectomy may show different outcomes based on the anatomy of the gastric tube.
Collapse
Affiliation(s)
- Barbara F Nadaleto
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Marco G Patti
- Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL
| |
Collapse
|
|
37
|
Abstract
Operative treatment of GERD has become more common since the introduction of LARS. Careful patient selection based on symptoms, response to medical therapy, and preoperative testing will optimize the chances for effective and durable postoperative control of symptoms. Complications of the LARS are rare and generally can be managed without reoperation. When reoperation is necessary for failed antireflux surgery, it should be performed by high-volume gastroesophageal surgeons.
Collapse
Affiliation(s)
- Robert B Yates
- Department of General Surgery, Center for Videoendoscopic Surgery, University of Washington, 1959 NE Pacific Street, Box 356410/Suite BB-487, Seattle, WA 98195, USA.
| | - Brant K Oelschlager
- Division of General Surgery, Department of Surgery, Center for Esophageal and Gastric Surgery, University of Washington, 1959 NE Pacific Street, Box 356410/Suite BB-487, Seattle, WA 98195, USA
| |
Collapse
|
|
38
|
Rodríguez L, Rodriguez P, Gómez B, Ayala JC, Oxenberg D, Perez-Castilla A, Netto MG, Soffer E, Boscardin WJ, Crowell MD. Two-year results of intermittent electrical stimulation of the lower esophageal sphincter treatment of gastroesophageal reflux disease. Surgery 2014; 157:556-67. [PMID: 25726315 DOI: 10.1016/j.surg.2014.10.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/22/2014] [Accepted: 10/28/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lower esophageal sphincter (LES) electrical stimulation therapy (EST) has been shown to improve outcome in gastroesophageal reflux disease (GERD) patients at 1 year. The aim of this open-label extension trial (NCT01578642) was to study the 2-year safety and efficacy of LES-EST in GERD patients. METHODS GERD patients responsive partially to proton pump inhibitors (PPI) with off-PPI GERD health-related quality of life (HRQL) of ≥20, 24-hour esophageal pH ≤4.0 for >5% of the time, hiatal hernia ≤3 cm, and esophagitis LA grade C or lower participated in this trial. Bipolar stitch electrodes and a pulse generator (EndoStim BV, The Hague, The Netherlands) were implanted laparoscopically. LES-EST at 20 Hz, 215 μs, 3-8 mAmp was delivered over 30-minute sessions, 6-12 sessions per day, starting on day 1 after implantation. Patients were evaluated using GERD-HRQL, symptom diaries, Short Form-12, and esophageal pH testing at regular intervals. Stimulation sessions were optimized based on residual symptoms and esophageal pH at follow-up. RESULTS Twenty-five patients (mean age [SD] = 52 [12] years; 14 men) were implanted successfully; 23 patients participated in the 2-year extension trial, and 21 completed their 2-year evaluation. At 2 years, there was improvement in their median GERD-HRQL on LES-EST compared with both their on-PPI (9 vs 0; P = .001) and off-PPI (23.5 vs. 0; P < .001) baseline scores. Median 24-hour distal esophageal acid exposure improved from 10% at baseline to 4% (per-protocol analysis; P < .001) at 2 years with 71% demonstrating either normalization or a ≥50% decrease in their distal esophageal acid exposure. All except 5 patients (16/21) reported complete cessation of PPI use; only 2 patients were using a PPI regularly (≥50% of days). There was significant improvement in sleep quality and daily symptoms of heartburn and regurgitation on LES-EST. At baseline, 92% of the subjects (22/24) reported that they were "unsatisfied" with their condition off-PPI and 71% (17/24) on-PPI compared with 0% (0/21) "unsatisfied" at the 24-month visits on LES-EST. There were no device- or therapy-related serious adverse events and no untoward sensation or dysphagia reported with LES-EST. CONCLUSION LES-EST is safe and effective for treating patients with GERD over a period of 2 years. LES-EST resulted in a significant and sustained improvement in GERD symptoms, and esophageal acid exposure and eliminated PPI use in majority of patients (16 of 21). Further, LES-EST was not associated with any gastrointestinal side effects or adverse events.
Collapse
Affiliation(s)
| | | | - Beatriz Gómez
- Department of Surgery, CCO Obesidad y Diabetes, Santiago, Chile
| | - Juan C Ayala
- Department of Gastroenterology, Clinic Indisa, Santiago, Chile
| | - Danny Oxenberg
- Department of Gastroenterology, Clinic Indisa, Santiago, Chile
| | | | - Manoel G Netto
- Department of Surgery, Gastro Obeso Center, Sao Paulo, Brazil
| | - Edy Soffer
- University of Southern California, Los Angeles, CA
| | | | | |
Collapse
|
|
39
|
Min MX, Ganz RA. Update in procedural therapy for GERD--magnetic sphincter augmentation, endoscopic transoral incisionless fundoplication vs laparoscopic Nissen fundoplication. Curr Gastroenterol Rep 2014; 16:374. [PMID: 24522889 DOI: 10.1007/s11894-014-0374-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common and progressive condition manifested by heartburn or regurgitation. Though Nissen fundoplication has been and remains the gold standard for procedural therapy for GERD, two newer interventions have gained popularity: magnetic sphincter augmentation (MSA), which entails the placement of a self expanding magnetic ring around the gastroesophageal (GE) junction, and transoral incisionless fundoplication (TIF), an endoscopic approach that creates a neogastroesophageal valve near the fundus. Collective data gathered from four studies published within the past year suggest that the three modalities share comparable effectiveness in pH monitoring and patient satisfaction, TIF may have a lower proton pump inhibitor cessation rate, and Nissen fundoplication required longer recovery time and had a more serious adverse effects profile. Large, prospective, randomized controlled studies are needed to reliably compare the three procedures.
Collapse
Affiliation(s)
- Michael X Min
- Department of Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | |
Collapse
|
|
40
|
Abstract
There has been a marked decline over the last several years in drug development for gastroesophageal reflux disease and specifically for nonerosive reflux disease (NERD), despite there being many areas of unmet need. In contrast, we have seen a proliferation, during the same period of time, in development of novel, nonmedical therapeutic strategies for NERD using cutting-edge technology. Presently, compliance and lifestyle modifications are readily available noninvasive therapeutic interventions for NERD. Other nonmedical therapies include, the Stretta procedure, transoral incisionless fundoplication, and the magnetic sphincter augmentation device (LINX). Antireflux surgery, in experienced hands, has been repeatedly shown to be efficacious in resolving NERD-related symptoms. Psychological therapeutic interventions and alternative medicine techniques, such as acupuncture, continue to show promise, especially in NERD patients who failed antireflux treatment.
Collapse
|
|
41
|
Kim M, Navarro F, Eruchalu CN, Augenstein VA, Heniford BT, Stefanidis D. Minimally invasive Roux-en-Y gastric bypass for fundoplication failure offers excellent gastroesophageal reflux control. Am Surg 2014; 80:696-703. [PMID: 24987903 DOI: 10.1177/000313481408000726] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Roux-en-Y gastric bypass (RYGB) may represent a superior alternative to reoperative fundoplication in patients with symptomatic failure. Our goal was to assess early outcomes of patients after RYGB for failed fundoplication. Records of patients who underwent fundoplication takedown and RYGB from March 2007 to June 2013 were reviewed for demographics, comorbidities, operative findings, and perioperative outcomes. Data are reported as medians (range). Forty-five patients who had undergone 64 prior antireflux procedures (range, one to three fundoplications) were identified. Median patient age was 56 years (range, 25 to 72 years) with a body mass index of 33 kg/m(2) (range, 22 to 51 kg/m(2)). Most patients had comorbidities: hypertension (60%), anxiety/depression (44.4%), dyslipidemia (33.3%), asthma (31%), obstructive sleep apnea (26.7%), arthritis (22.2%), and diabetes (11.1%). Median symptom-free interval was 3 years (range, 0 to 25 years). All patients had an anatomic reason for failure: 83 per cent had a hiatal hernia and 35 per cent had a slipped Nissen fundoplication. The procedures were accomplished laparoscopically in 28, robotically in 13, and open in four cases. Median operative time was 367 minutes (range, 190 to 600 minutes) and estimated blood loss averaged 100 mL (range, 25 to 500 mL). Five patients (11%) required reoperation: one for an anastomotic leak, one for anastomotic obstruction, and three for early obstruction resulting from adhesions. Two patients developed respiratory failure requiring prolonged mechanical ventilation. Length of stay averaged four days (range, 1 to 33 days) with two readmissions: one for melena and one for vomiting and dehydration; neither required intervention. There was no mortality. At 11 months of follow-up (range, 2.3 to 54 months), 93.3 per cent of patients were symptom-free. When primary fundoplication for gastroesophageal reflux disease fails, fundoplication takedown and RYGB can be accomplished safely with minimally invasive techniques. The conversion to a RYGB has an acceptable perioperative morbidity and excellent early symptom control, and, therefore, should be considered for reoperative patients gastroesophageal reflux disease.
Collapse
Affiliation(s)
- Mimi Kim
- Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | | | | | | | | |
Collapse
|
|
42
|
Telem DA, Altieri M, Gracia G, Pryor AD. Perioperative outcome of esophageal fundoplication for gastroesophageal reflux disease in obese and morbidly obese patients. Am J Surg 2014; 208:163-8. [PMID: 24881017 DOI: 10.1016/j.amjsurg.2014.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 12/25/2013] [Accepted: 02/27/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND To determine the perioperative safety of esophageal fundoplication for gastroesophageal reflux disease (GERD) in patients with body mass index (BMI) ≥ 35 kg/m(2). METHODS A retrospective review of 4,231 patients who underwent fundoplication for GERD from 2005 to 2009 was performed. Patients were identified via National Surgical Quality Improvement Program and grouped by BMI < 35 versus BMI ≥ 35 kg/m(2). Univariate analysis compared 30-day outcomes. RESULTS Of the 4,231 patients, 3,496 (83%) had BMI < 35 kg/m(2) and 735 (17%) had BMI ≥ 35 kg/m(2). Mean BMI for each cohort was 27.9 versus 39.1, respectively. Patients with BMI ≥ 35 kg/m(2) had significantly longer operative times (129.7 vs 118 minutes, P < .0001) and increased American Society of Anesthesiologists scores (2.43 vs 2.3, P = .001). The overall complication rate was 1.96%. No difference was demonstrated by BMI in complication rate or hospital length of stay. Increased American Society of Anesthesiologists score, diabetes, black race, longer operative time, and intraoperative transfusion significantly increased postoperative complication rates. CONCLUSIONS No increased risk is conferred to morbidly obese patients who undergo fundoplication for GERD management. This study identified independent patient risk factors for postoperative complication following esophageal fundoplication.
Collapse
Affiliation(s)
- Dana A Telem
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA.
| | - Maria Altieri
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
| | - Gerald Gracia
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
| | - Aurora D Pryor
- Division of Laparoscopic, Bariatric and Advanced GI Surgery, Stony Brook University Medical Center, 100 Nichols Road, Stony Brook, NY 11794, USA
| |
Collapse
|
|
43
|
Kim D, Velanovich V. Surgical treatment of GERD: where have we been and where are we going? Gastroenterol Clin North Am 2014; 43:135-45. [PMID: 24503364 DOI: 10.1016/j.gtc.2013.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Surgical management of gastroesophageal reflux disease has evolved from relatively invasive procedures requiring open laparotomy or thoracotomy to minimally invasive laparoscopic techniques. Although side effects may still occur, with careful patient selection and good technique, the overall symptomatic control leads to satisfaction rates in the 90% range. Unfortunately, the next evolution to endoluminal techniques has not been as successful. Reliable devices are still awaited that consistently produce long-term symptomatic relief with correction of pathologic reflux. However, newer laparoscopically placed devices hold promise in achieving equivalent symptomatic relief with fewer side effects. Clinical trials are still forthcoming.
Collapse
Affiliation(s)
- David Kim
- Division of General Surgery, University of South Florida, One Tampa General Circle, Tampa, FL 33606, USA
| | - Vic Velanovich
- Division of General Surgery, University of South Florida, One Tampa General Circle, Tampa, FL 33606, USA.
| |
Collapse
|
|
44
|
Elective antireflux surgery in the US: an analysis of national trends in utilization and inpatient outcomes from 2005 to 2010. Surg Endosc 2014; 28:1712-9. [DOI: 10.1007/s00464-013-3380-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/09/2013] [Indexed: 10/25/2022]
|
|
45
|
Van Meer S, Bogte A, Siersema PD. Long-term follow up in patients with gastroesophageal reflux disease with specific emphasis on reflux symptoms, use of anti-reflux medication and anti-reflux surgery outcome: a retrospective study. Scand J Gastroenterol 2013; 48:1242-8. [PMID: 24041112 DOI: 10.3109/00365521.2013.834378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Various treatment modalities are currently being used in patients with gastroesophageal reflux disease (GERD); however, long-term outcome is not clear. The aim is to evaluate long-term results of GERD treatments with regard to reflux symptoms, use of anti-reflux medication and anti-reflux surgery outcome. METHODS Patients who had undergone 24-h pH monitoring for reflux symptoms between January 2002 and March 2012 were invited to fill out the Reflux Disease Questionnaire (RDQ) and a general questionnaire. Patients with and without anti-reflux surgery were compared using multiple linear and logistic regression models. RESULTS In total, 1027 of 2190 included patients (47%) returned the questionnaires. After exclusion due to predefined criteria, 477 patients were analyzed. Median total RDQ score was 18 points (10.2% symptom-free) in the conservative group (n = 304) and 10 points (31.2% symptom-free) in the surgical group (n = 173) after a mean follow up of 5.1 years. Daily proton pomp inhibitor (PPI) use was higher in the conservative group than in the surgical group (80.9% vs. 51.4%, p = 0.000). Linear regression analysis showed an association between RDQ scores and anti-reflux surgery (β = -5.477, p = 0.001) and male gender (β = -4.306, p = 0.006). Logistic regression analyses showed that daily PPI use was lower in patients who underwent anti-reflux surgery (odds ratio [OR] = 0.24, p = 0.000), while it increased with age (OR = 1.03, p = 0.000). CONCLUSIONS There is still a high prevalence of typical reflux symptoms and daily PPI use in GERD patients after >5 years of follow up. Male patients and patients who had undergone anti-reflux surgery were more often asymptomatic. Daily PPI use was lower after anti-reflux surgery, while it increased with age.
Collapse
Affiliation(s)
- Suzanne Van Meer
- Department of Gastroenterology and Hepatology, University Medical Center , Utrecht , The Netherlands
| | | | | |
Collapse
|
|
46
|
Bonavina L, Siboni S, Saino GI, Cavadas D, Braghetto I, Csendes A, Korn O, Figueredo EJ, Swanstrom LL, Wassenaar E. Outcomes of esophageal surgery, especially of the lower esophageal sphincter. Ann N Y Acad Sci 2013; 1300:29-42. [PMID: 24117632 DOI: 10.1111/nyas.12232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper includes commentaries on outcomes of esophageal surgery, including the mechanisms by which fundoduplication improves lower esophageal sphincter (LES) pressure; the efficacy of the Linx™ management system in improving LES function; the utility of radiologic characterization of antireflux valves following surgery; the correlation between endoscopic findings and reported symptoms following antireflux surgery; the links between laparoscopic sleeve gastrectomy and decreased LES pressure, endoscopic esophagitis, and gastroesophageal reflux disease (GERD); the less favorable outcomes following fundoduplication among obese patients; the application of bioprosthetic meshes to reinforce hiatal repair and decrease the incidence of paraesophageal hernia; the efficacy of endoluminal antireflux procedures, and the limited efficacy of revisional antireflux operations, underscoring the importance of good primary surgery and diligent work-up to prevent the necessity of revisional procedures.
Collapse
Affiliation(s)
- Luigi Bonavina
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Stefano Siboni
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Greta I Saino
- General Surgery, IRCCS, University of Milano, Milano, Italy
| | - Demetrio Cavadas
- Department of Surgery, Hospital Italiano, Buenos Aires, Argentina
| | - Italo Braghetto
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Attila Csendes
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Department of Surgery, University Hospital, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Edgar J Figueredo
- Department of Surgery, University of Washington, Seattle, Washington
| | | | - Eelco Wassenaar
- Department of Surgery, University of Washington, Seattle, Washington
| |
Collapse
|
|
47
|
Trends in Use of Upper Abdominal Procedures in Sweden 1998–2011: A Population-Based Study. World J Surg 2013; 38:33-9. [DOI: 10.1007/s00268-013-2231-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
|
48
|
Richter JE. Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol 2013; 11:465-71; quiz e39. [PMID: 23267868 DOI: 10.1016/j.cgh.2012.12.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 12/06/2012] [Accepted: 12/07/2012] [Indexed: 02/06/2023]
Abstract
Even skilled surgeons will have complications after antireflux surgery. Fortunately, the mortality is low (<1%) with laparoscopic surgery, immediate postoperative morbidity is uncommon (5%-20%), and conversion to an open operation is <2.5%. Common late postoperative complications include gas-bloat syndrome (up to 85%), dysphagia (10%-50%), diarrhea (18%-33%), and recurrent heartburn (10%-62%). Most of these complications improve during the 3-6 months after surgery. Dietary modifications, pharmacologic therapies, and esophageal dilation may be helpful. Failures after antireflux surgery usually occur within the first 2 years after the initial operation. They fall into 5 patterns: herniation of the fundoplication into the chest, slipped fundoplication, tight fundoplication, paraesophageal hernia, and malposition of the fundoplication. Reoperation rates range from 0%-15% and should be performed by experienced foregut surgeons.
Collapse
Affiliation(s)
- Joel E Richter
- Division of Digestive Diseases and Nutrition, Center for Esophageal and Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida 33612, USA.
| |
Collapse
|
|
49
|
|
|
50
|
Wilshire CL, Watson TJ. Surgical management of gastroesophageal reflux disease. Gastroenterol Clin North Am 2013; 42:119-31. [PMID: 23452634 DOI: 10.1016/j.gtc.2012.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Antireflux surgery has become a well-established therapy for gastroesophageal reflux disease (GERD) and its complications. The popularization of minimally invasive surgical techniques has brought about a revolution in the use of fundoplication for the long-term management of GERD. A reliable and objective understanding of the outcomes following fundoplication is important for all physicians treating GERD, so that informed decisions can be made regarding the optimal treatment strategy for a given patient. With ongoing study, the appropriate indications for surgical intervention among the array of potential antireflux therapies will continue to be elucidated.
Collapse
Affiliation(s)
- Candice L Wilshire
- Division of Thoracic and Foregut Surgery, Department of Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | | |
Collapse
|