Impact of anatomical wrap position on the outcome of Nissen fundoplication

Donkervoort, Sandra; Bais, J. E.; Jong, H. Rijnhart‐de; Gooszen, Hein G.

doi:10.1002/bjs.4123

Cited by 20 publications

(20 citation statements)

References 29 publications

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“…18 What our study has shown, however, is that objective evidence of anatomical failure does not appear to correlate with subjective recurrence of symptoms. This finding is in agreement with that from Donkervoort et al, 17 who also reported that the repair did not stand the test of time anatomically in 55% of patients but with no demonstrable influence on subjective outcome. It is possible that the proportional increase in interclip distance (25% and 50%) may be too rigorous owing to the possible lie of the wrap marker clips, although similar variation in lie is not possible for the crural clips.…”

Section: Discussionsupporting

confidence: 93%

“…Donkervoort et al 17 undertook barium swallows at 2 years' postoperatively as part of their follow-up, which is a commendable time period. We have noticed a progressive reduction in the number of patients willing to attend followup appointments (18 patients in this study).…”

Section: Discussionmentioning

confidence: 99%

“…6,13-16 Donkervoort et al 17 studied anatomical wrap position and the outcome following laparoscopic Nissen fundoplication and, 2 years' postoperatively, found that the anatomical repair failed in 27% using 'strict' criteria A degree of anatomical failure is common, and the most common failure is intrathoracic wrap herniation. We have assessed anatomical integrity of the crural repair and wrap using marking Liga clips placed at the time of surgery and compared this with symptomatic outcome.…”

Section: Ann R Coll Surg Engl 2010; 92: 131-135 131mentioning

confidence: 99%

“…[10][11][12] In a series of 307 re-do fundoplications, Smith et al 6 found that fundoplication herniation was the most common mechanism of failure. Symptomatic patients with objective evidence of failure of LARS can be offered re-do surgery: several studies have demonstrated that this can be safely undertaken laparoscopically.6,13-16 Donkervoort et al 17 studied anatomical wrap position and the outcome following laparoscopic Nissen fundoplication and, 2 years' postoperatively, found that the anatomical repair failed in 27% using 'strict' criteria A degree of anatomical failure is common, and the most common failure is intrathoracic wrap herniation. We have assessed anatomical integrity of the crural repair and wrap using marking Liga clips placed at the time of surgery and compared this with symptomatic outcome.…”

mentioning

confidence: 99%

“…6,13-16 Donkervoort et al 17 studied anatomical wrap position and the outcome following laparoscopic Nissen fundoplication and, 2 years' postoperatively, found that the anatomical repair failed in 27% using 'strict' criteria and 55% using 'less strict' criteria, although there was no demonstrable influence on subjective outcome.…”

mentioning

confidence: 99%

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Anatomical failure following laparoscopic antireflux surgery (LARS); does it really matter?

Dunne

Stratford²,

Jones³

et al. 2010

annals

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Ann R Coll Surg Engl 2010; 92: 131-135 131Correction of the physiological factors contributing to gastrooesophageal reflux disease (GORD) is only possible by surgical fundoplication and, since the advent of laparoscopic fundoplication by Dallemagne et al. in 1991, 1 is an increasingly attractive option for patients due to low morbidity and greatly reduced length of hospital stay. As a result, laparoscopic antireflux surgery (LARS) has become the gold standard in the surgical treatment of GORD. Lundell et al. 2 reported a 7-year follow-up comparing results in patients randomised to proton-pump inhibition or open antireflux surgery, and surgery was shown to be more effective at controlling overall disease symptoms, but post-fundoplication complaints were problematic.Failure rates of laparoscopic Nissen fundoplication vary from 2% to 30%, 3-7 depending on the definition of 'failure'. Both patients and clinicians may interpret resumption of medical treatment as failure, but the majority of patients taking antireflux medication are taking it for atypical or non-reflux related symptoms.7-9 An anatomical explanation for failed reflux surgery can often be found, such as breakdown of the fundoplication, an over-tight wrap, intrathoracic herniation of the wrap or telescoping of the lower oesophageal sphincter through the wrap. [10][11][12] In a series of 307 re-do fundoplications, Smith et al. 6 found that fundoplication herniation was the most common mechanism of failure. Symptomatic patients with objective evidence of failure of LARS can be offered re-do surgery: several studies have demonstrated that this can be safely undertaken laparoscopically.6,13-16 Donkervoort et al. 17 studied anatomical wrap position and the outcome following laparoscopic Nissen fundoplication and, 2 years' postoperatively, found that the anatomical repair failed in 27% using 'strict' criteria A degree of anatomical failure is common, and the most common failure is intrathoracic wrap herniation. We have assessed anatomical integrity of the crural repair and wrap using marking Liga clips placed at the time of surgery and compared this with symptomatic outcome. PATIENTS AND METHODS A prospective study was undertaken on 50 patients who underwent LARS in a single centre over a 3-year period. Each had an X-ray on the first postoperative day and a barium swallow at 6 months at which the distance was measured between the marking Liga clips. An increase in interclip distance of > 25-49% was deemed 'mild separation', and an increase of > 50% 'moderate separation'. Patients completed a standardised symptom questionnaire at 6 months. RESULTS At 6 months' postoperatively, 22% had mild separation of the crural repair with a mean Visick score of 1.18, and 54% had moderate separation with a mean Visick score of 1.26. Mild separation of the wrap occurred in 28% with a mean Visick score of 1.21 and 22% moderate separation with a mean Visick score of 1.18. Three percent had mild separation of both the crural repair and wrap with a mean Visick score of 1.0, ...

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Ann R Coll Surg Engl 2010; 92: 131-135 131mentioning

confidence: 99%

mentioning

confidence: 99%

“…6,13-16 Donkervoort et al 17 studied anatomical wrap position and the outcome following laparoscopic Nissen fundoplication and, 2 years' postoperatively, found that the anatomical repair failed in 27% using 'strict' criteria and 55% using 'less strict' criteria, although there was no demonstrable influence on subjective outcome.…”

mentioning

confidence: 99%

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