Antireflux Surgery

Hinder, Ronald A.; Libbey, Jeffrey S.; Górecki, Piotr; Bammer, T.

doi:10.1016/s0889-8553(05)70101-1

Cited by 43 publications

(6 citation statements)

References 63 publications

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“…An estimated 44% of the US adult population has symptoms of heartburn at least once per month [1], and approximately 14% of Americans have gastroesophageal symptoms weekly, and 7% have symptoms daily [1–3]. The annual total (direct and indirect) cost associated with management of GERD is estimated at more than US $14 billion in the USA, 60% of which is spent on medication [4].…”

Section: Introductionmentioning

confidence: 99%

GERD-Related Health Care Utilization, Therapy, and Reasons for Transfer of GERD Patients Between Primary Care Providers and Gastroenterologists in a US Managed Care Setting

et al. 2009

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PurposePatient flow between primary care physicians and gastroenterologists in the continuum of gastroesophageal reflux disease (GERD) care is poorly understood. Using administrative claims data from a large US health plan linked with data abstracted from medical records, we examined: health care resource utilization for GERD subjects treated by primary care physicians (PCPs) and gastroenterologists (GEs), determinants of GERD subject transfer between these physician types, and reasons for GERD therapy change.ResultsWithin a sample of 169,884 patients, 211,043 PCP-based episodes of care and 40,304 GE-based episodes of care were developed. In unadjusted comparisons, GE episodes were characterized by more endoscopic procedures, on average (50.5/100 episodes), compared with PCP episodes (6.3/100, P < 0.001). Multivariate analysis showed that patients with esophagitis had 57.3% higher odds (P < 0.01) of transfer from PCP to GE compared with patients without esophagitis; patients with esophageal stricture had 98.6% higher odds (P < 0.01) of PCP-GE transfer. Patients with endoscopy during a first GE episode had 32.2% higher odds of transfer to a PCP (P < 0.01). The principal reasons for change in GERD therapy were no change or worsening of symptoms (51.7% of PCP charts; 9.5% of GE charts) and lack of response to therapy (51.7% of PCP charts, 26.2% of GE charts).ConclusionResource utilization varies greatly based on the physician’s specialty. We infer that timely transfer of GERD patients to gastroenterologists when empiric treatment is insufficient may lead to more efficient clinical management.

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Section: Introductionmentioning

confidence: 99%

GERD-Related Health Care Utilization, Therapy, and Reasons for Transfer of GERD Patients Between Primary Care Providers and Gastroenterologists in a US Managed Care Setting

et al. 2009

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“…Gastroesophageal reflux is the most common esophageal motility disorder. Approximately 40% of the adult population have reflux symptoms at least once a month, 14% weekly, and 7% daily [ 7 , 12 , 13 ]. Of these, about 0.4% require surgical or medical treatment [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic clipping of the Z-line (CMZL) helps recognize anatomical failures after Nissen fundoplication: technical report of a new method.

Barkhatov¹,

Kazaryan²,

Aasen³

et al. 2015

Videosurgery and Other Miniinvasive Techniques

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IntroductionNearly 15% of patients after laparoscopic antireflux surgery experience recurrence of symptoms or develop new gastrointestinal symptoms. Some of them require redo procedures. It can be demanding to reveal anatomical failure after previous fundoplication.AimTo present a method which assists in recognition of anatomical failures after Nissen fundoplication.Material and methodsFive patients with previous laparoscopic Nissen fundoplication and severe gastrointestinal symptoms were included in this study. During the esophagogastroduodenoscopy (EGDS) two radiopaque metal clips were placed to mark the Z-line (“clips-marked Z-line” – CMZL). It was done to achieve precise visualization of the gastroesophageal junction area in the video contrast investigation. Distinctions between conclusions after the EGDS, ordinary video contrast investigation, video contrast investigation with CMZL and intraoperative findings were analyzed.ResultsAll patients underwent laparoscopic refundoplication with good postoperative results. There were 4 cases misdiagnosed by contrast investigation without clips and four cases misdiagnosed by EGDS. Endoscopic clipping helped to recognize correctly all anatomical failures.ConclusionsApplying CMZL as a routine investigation before redo fundoplication can reduce frequency of misdiagnosis and help to perform redo fundoplication in appropriate patients, but it requires further studies on larger cohorts of patients.

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“…Laxity of the fundoplication can progress to various structural dysfunctions of the fundoplication [Figure 2], as described by the Hinder and Horgan classifications. 31, 32 A common dysfunction is hiatal herniation where the esophagogastric junction is displaced proximally through the hiatus [Figure 2c]. Herniation can result from partial or complete wrap disruption, or slippage of stomach proximal to the fundoplication in the setting of an intact or partially disrupted wrap [Figure 3].…”

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

“…The reported success rate of subsequent revisions is lower than for the primary fundoplication, and continues to decrease with subsequent reoperations. 31, 36 The mortality rate for reoperation is approximately 1%, however complications of all types (perforation, postoperative leak, gastrotomy, vagal nerve injury and treatment failure) is significantly increased, particularly for multiple time redos. 37, 38 In a study of 940 patients undergoing primary or redo antireflux surgery fewer patients were satisfied with subsequent reinterventions at follow-up (Excellent satisfaction following: primary antireflux surgery 91%, first redo 76%, second redo 49%, and third redo 33%).…”

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

“…46 While the mechanism of post-fundoplication diarrhea is not well understood, suggested mechanisms include accelerated gastric emptying, vagal nerve injury, postoperative dietary modifications, and unrecognized pre-existing irritable bowel syndrome. 29, 31, 47, 48 Concomitant cholecystectomy reportedly increases the risk for postoperative diarrhea. 29…”

Section: Complications Of Laparoscopic Fundoplicationmentioning

confidence: 99%

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Complications of Antireflux Surgery

Yadlapati

Hungness

Pandolfino

2018

American Journal of Gastroenterology

103

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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.

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Antireflux Surgery

Cited by 43 publications

References 63 publications

GERD-Related Health Care Utilization, Therapy, and Reasons for Transfer of GERD Patients Between Primary Care Providers and Gastroenterologists in a US Managed Care Setting

GERD-Related Health Care Utilization, Therapy, and Reasons for Transfer of GERD Patients Between Primary Care Providers and Gastroenterologists in a US Managed Care Setting

Endoscopic clipping of the Z-line (CMZL) helps recognize anatomical failures after Nissen fundoplication: technical report of a new method.

Complications of Antireflux Surgery

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