A Tailored Approach to Laparoscopic Fundoplication: Outcomes in Patients with Esophageal Dysmotility

Wong, Harry J.; Vierra, Mason; Hedberg, Mason; Attaar, Mikhail; Su, Bailey; Kuchta, Kristine; Chiao, Gene; Linn, John G.; Ujiki, Michael

doi:10.1007/s11605-022-05452-4

Cited by 12 publications

(2 citation statements)

References 21 publications

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“…Ineffective esophageal motility (IEM) is de ned as ≥50% ineffective swallowing or DCI<450 mmHg-S-cm [15,16]. Some scholars have conducted esophageal motility examinations on GERD and IEM patients through HRM and found that patients' esophageal motility function and clinical symptoms have improved signi cantly after laparoscopic gastric fundoplication [17][18][19][20], which is consistent with the risk factors in our prediction model. However, the increase in risk may be further modulated by related comorbidities.…”

Section: Discussionsupporting

confidence: 70%

Machine Learning Risk Prediction Model for 6-Month Postoperative Prognosis after Anti-Reflux Surgery for Gastroesophageal Reflux Disease

Liu,

Ma,

et al. 2023

Preprint

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Background: Anti-reflux surgery is an effective treatment for GERD, but personalized prognosis tools are lacking. Methods: This prospective study included patients undergoing laparoscopic anti-reflux surgery at a single center. The outcome of interest was the 6-month postoperative prognosis. Random forest analysis was used to identify predictors, and multivariate logistic regression was used to construct a clinical prediction model. Model performance was evaluated using leave-one-out cross-validation and area under the curve (AUC) Results: Seven important variables were identified, and two independent factors, "distal contractile integral" and "proximal distance of the lower esophageal sphincter," were selected for the clinical prediction model. The model demonstrated an AUC of 0.902 (CI: 0.8458-0.9587), and the leave-one-out cross-validation yielded an ROC of 0.890, with sensitivity of 0.575, specificity of 0.920, and accuracy of 0.826. The model showed good discrimination, calibration, and clinical utility. Conclusion: A validated clinical prediction model was developed to effectively predict the risk of poor prognosis after anti-reflux surgery. Its implementation can assist patients and surgeons in making informed decisions and improving patient outcomes.

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Section: Discussionsupporting

confidence: 70%

Machine Learning Risk Prediction Model for 6-Month Postoperative Prognosis after Anti-Reflux Surgery for Gastroesophageal Reflux Disease

Liu,

Ma,

et al. 2023

Preprint

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“…Through this “tailoring,” patients with limited motility were allocated to a laparoscopic Toupet fundoplication and those with normal motility to a Nissen fundoplication [ 4 ]. Long-term follow-up studies confirmed a lower rate of dysphagia and other side effects after Toupet Fundoplication with similarly good symptom control [ 5 , 6 ]. As a result, Toupet fundoplication was considered the “one fits-all” solution for all patients, regardless of motility.…”

Section: Introductionmentioning

confidence: 99%

Lap. Nissen fundoplication leads to better respiratory symptom control than Toupet in the long term of 20 years

Gehwolf,

Agerer,

Stacul

et al. 2023

Langenbecks Arch Surg

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Introduction Having performed anti-reflux surgery for thirty years, it was important to reexamine our patients in the long term to enlarge the body of evidence concerning classical and extraesophageal symptoms that are differently controlled by Nissen or Toupet fundoplication. Objectives We report a cohort of 155 GERD patients who underwent fundoplication within a tailored approach between 1994 and 2000. Changes in the perioperative functional outcome, GERD symptoms, and quality of life are being analyzed 10 and 20 years after the operation. Results The operation resulted in a superior quality of life compared to a patient cohort treated with PPI therapy. We found that both surgical methods (laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication) cure classical symptoms equally (heartburn, regurgitation, and dysphagia). GERD patients receiving a Toupet fundoplication seem more likely to suffer from extraesophageal GERD symptoms 10 and 20 years after surgery than patients with a Nissen fundoplication. On the other hand, some patients with Nissen fundoplication report dysphagia even 10 and 20 years after surgery. Conclusion Both the laparoscopic Nissen and Toupet fundoplications provide excellent symptom control in the long term. Moreover, the Nissen fundoplication seems to be superior in controlling extraesophageal reflux symptoms, but at the expense of dysphagia. In summary, tailoring the operation based on symptoms seems advantageous.

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Refluxkrankheit

Leers,

Fuchs

2023

Springer Reference Medizin

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A Tailored Approach to Laparoscopic Fundoplication: Outcomes in Patients with Esophageal Dysmotility

Cited by 12 publications

References 21 publications

Machine Learning Risk Prediction Model for 6-Month Postoperative Prognosis after Anti-Reflux Surgery for Gastroesophageal Reflux Disease

Machine Learning Risk Prediction Model for 6-Month Postoperative Prognosis after Anti-Reflux Surgery for Gastroesophageal Reflux Disease

Lap. Nissen fundoplication leads to better respiratory symptom control than Toupet in the long term of 20 years

Refluxkrankheit

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