Failure After Fundoplication: Re-Fundoplication? Is There a Room for Gastrectomy? In Which Clinical Scenaries?

Braghetto, Italo; Csendes, Attila

doi:10.1590/0102-672020190001e1440

Cited by 13 publications

(9 citation statements)

References 56 publications

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“…Partial or total fundoplication in a systematic or selective manner is also questionable, and it can be applied only to patients with previous reflux symptoms or in all cases . 17 , 18 In this study, fundoplication was performed in 94.12% of cases (preferably using the Nissen technique – 52.94%) considering that the extensive esophageal dissection close to the hiatus, the division of the posterior phrenoesophageal ligament and the break of the esophageal continence mechanism by the large existing hiatal hernia, could result in gastroesophageal reflux. In addition, fundoplication would reduce the mobility of the gastric fundus, reducing the risk of herniation to the chest cavity recurrence.…”

Section: Discussionmentioning

confidence: 99%

Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus

Lopes

Chaim

Santos

et al. 2020

JSLS

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Background: Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial.Methods: Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital.Results: Thirty patients (34 surgical procedures -4 reoperations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 6 32.65 and the mean body mass index was 27.11 6 3.5 kg/m 2 . The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 6 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 6 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 6 32.6 months.Conclusions: Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.

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Section: Discussionmentioning

confidence: 99%

Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus

Lopes

Chaim

Santos

et al. 2020

JSLS

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“…Healing rates were compared among groups. The χ 2 test and t-test were used, respectively, for enumeration and measurement data.\\n\\nRESULTS: There were 176 H. pylori positive (with 92 eradication cases studied 846 patients with reflux esophagitis who underwent treatment with pantoprazole (40 mg). After four weeks of treatment the reflux esophagitis healing rate was 86.6% in patients with HP positive.…”

Section: Discussionmentioning

confidence: 99%

“…The relationship between HP and diseases related to esophageal acid reflux is uncertain 2 , 23 . It is currently advocated that the presence of this bacterium in the gastric mucosa may trigger a protective effect for patients with gastroesophageal reflux disease (GERD), both for esophagitis and for the development of EB and esophageal adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

Is There a Relation Between Helybacter Pylori and Intestinal Metaplasia in Short Column Epitelization Up to 10 Mm in the Distal Esophagus?

Degiovani

Ribas²,

Czeczko³

et al. 2019

ABCD, arq. bras. cir. dig.

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ABSTRATBackground: The presence of intestinal metaplasia in the distal esophagus (Barrett’s esophagus) is an important precursor of adenocarcinoma. Knowledge of the risk factors and the process by which the Barrett develops is very important and Helicobacter pylori (HP) can contribute to this development. Aim: To analyze the impact of HP in the gastric mucosa with intestinal metaplasia in the distal esophagus in areas of columnar epithelialization smaller than 10 mm in length and epidemiological data on prevalence Method: A retrospective study in which were included 373 consecutive patients diagnosed with columnar epithelium in the distal esophagus was done. In all, HP was investigated by urease and histology, exclusion and inclusion factors were applied and patients were divided into two groups: the first grouping the ones without histological diagnosis of Barrett’s esophagus (235-63%) and the second with it (138-37%). Results:There was no significant difference between HP and non-HP patients in relation to the probability of having intestinal metaplasia (p=0.587). When related to the general group, there was an inverse association between the bacterium and the columnar epithelia in the distal esophagus. Age (p=0.031), gender (p=0.013) and HP (p=0.613) when related together to intestinal metaplasia showed no significant relation. In isolation, when related to age and gender, regardless of HP, results confirmed that patients in more advanced age and women present a higher incidence of intestinal metaplasia. Conclusion:There is an inverse relation between HP and the areas of columnar epithelization in the distal esophagus, regardless of the presence or absence of intestinal metaplasia. Age and gender, regardless of HP, showed higher prevalence in women and in older the number of cases with intestinal metaplasia in the distal esophagus.

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“…Concurrent with the increase number of LFP over the last two decades 8,14,16,21 the number of dissatisfied patients, presenting relapses or new symptoms after surgery has also arrised 2 , 11 , 16 , 21 . Given this scenario, precise endoscopic evaluation of valve fundoplication is extremely important because it allows the medical team to recognize abnormalities and to establish treatment strategies, especially if surgical reintervention is being considered 21 , 25 .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Evaluation of Post-Fundoplication Anatomy and Correlation With Symptomatology

Martins

Souza

Ruas

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. Aim: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. Method: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). Results: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). Conclusion: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.

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Failure After Fundoplication: Re-Fundoplication? Is There a Room for Gastrectomy? In Which Clinical Scenaries?

Cited by 13 publications

References 56 publications

Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus

Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus

Is There a Relation Between Helybacter Pylori and Intestinal Metaplasia in Short Column Epitelization Up to 10 Mm in the Distal Esophagus?

Endoscopic Evaluation of Post-Fundoplication Anatomy and Correlation With Symptomatology

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