Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication

Park, Sangjun; Park, Shin-Hoo; Kim, Min Seo; Kwak, Ji Soo; Lee, Inhyeok; Kwon, Yeongkeun; Lee, Chang Min; Choi, Hyuk Soon; Keum, Bora; Yang, Kyung-Sook; Park, Joong-Min

doi:10.1097/js9.0000000000000274

Cited by 4 publications

(1 citation statement)

References 62 publications

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“…Additionally, a lower BMI tended to contribute to fewer reflux symptoms at 6 months ( P =0.058; Table 4 ). BMI≤23.7 kg/m 2 was reportedly associated with the resolution of reflux symptoms after anti-reflux surgery 36 . Delayed gastric emptying progressively reduces pressure on the esophagogastric junction and aggravates reflux symptoms 37 .…”

Section: Discussionmentioning

confidence: 99%

Reappraisal of optimal reconstruction after distal gastrectomy – a study based on KLASS-07 database

Park,

Hur,

Park

et al. 2023

International Journal of Surgery

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Backgrounds: This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG). Material and methods: We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups. Results: In endoscopic findings, bile reflux was the lowest in the RY group (n=67), followed by the BII-B (n=183) and BII groups (n=147) at 1 year (3.0% vs. 67.8% vs. 84.4%, all P<0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups. Conclusions: BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms, but failed to reduce C30 nausea symptoms, postoperatively.

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Section: Discussionmentioning

confidence: 99%

Reappraisal of optimal reconstruction after distal gastrectomy – a study based on KLASS-07 database

Park,

Hur,

Park

et al. 2023

International Journal of Surgery

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Bolus exposure as a novel predictor of postoperative symptom resolution after laparoscopic Nissen fundoplication: a two-institutional retrospective cohort study

Jung,

Lee,

Lee

et al. 2024

International Journal of Surgery

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Background: Even in the absence of definite evidence of pathological acid reflux, antireflux surgery (ARS) can still effectively improve gastroesophageal reflux symptoms. Nonetheless, predicting postoperative reflux symptom improvement has been primarily dependent on acid-based parameters. No objective index reflecting both acid and non-acid reflux was identified to select ARS candidates. Materials and methods: Prospectively collected data of 121 patients with gastroesophageal reflux disease (GERD), who underwent laparoscopic Nissen fundoplication from two institutions, were retrospectively reviewed. The patients reported preoperative and postoperative GERD symptoms using the Korean version of the GERD questionnaire, along with the gastroesophageal reflux disease-health-related quality of life (GERD-HRQL). The patients assessed for reflux symptoms using bolus exposure, acid exposure time (AET), and DeMeester score (DMS) as measurements were selected. For each reflux parameter, its association, correlation, and predictive capacity of the degree of postoperative symptom resolution were analyzed using chi-squared tests, point-biserial correlations, logistic regression analyses, and receiver operating characteristic curve analyses. Results: 72 patients were eligible for this study. Bolus exposure was superior to the other parameters in terms of the degree of association and correlation with resolution of typical symptoms. Bolus exposure also showed a higher diagnostic accuracy in predicting the resolution of epigastric pain (area under the curve [AUC]=0.723, P=0.013) and regurgitation (AUC=0.981, P<0.001). Secondary analyses were performed in patients without pathological reflux, defined as the DMS-negative (DMS<14.7) or AET-negative (AET<6%) groups. In the secondary analyses, bolus exposure showed considerable diagnostic accuracy with statistical significance for all typical symptoms in both in the DMS-negative (heartburn: AUC=0.717, P=0.025; epigastric pain: AUC=0.717, P=0.025; regurgitation: AUC=0.975, P<0.001) and AET-negative (heartburn: AUC=0.681, P=0.045; epigastric pain: AUC=0.749, P=0.009; regurgitation: AUC=0.975, P<0.001) groups. Conclusion: Bolus exposure, a parameter of total reflux, was superior to AET or DMS in defining candidates for ARS. Further studies investigating the surgical indications for ARS in patients with non-acid reflux using bolus exposure are required.

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How to select patients for antireflux surgery: surgical indications and predisposing factors to predict the outcome

Park¹

2023

Foregut Surg

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Exploring objective factors to predict successful outcomes after laparoscopic Nissen fundoplication

Cited by 4 publications

References 62 publications

Reappraisal of optimal reconstruction after distal gastrectomy – a study based on KLASS-07 database

Reappraisal of optimal reconstruction after distal gastrectomy – a study based on KLASS-07 database

Bolus exposure as a novel predictor of postoperative symptom resolution after laparoscopic Nissen fundoplication: a two-institutional retrospective cohort study

How to select patients for antireflux surgery: surgical indications and predisposing factors to predict the outcome

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