Laparoscopic Antireflux Surgery

Pessaux, Patrick; Arnaud, Jean‐Pierre; Delattre, Jean-François; Meyer, Christian; Baulieux, J.; Mosnier, H

doi:10.1001/archsurg.140.10.946

Cited by 125 publications

(27 citation statements)

References 38 publications

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“…Similarly, in a retrospective cohort study of 1340 patients undergoing LNF, partial posterior fundoplication (PF), or AF, satisfaction rates were comparable across all surgical techniques. 17 Likewise, in a cohort study comparing LNF versus Toupet fundoplication, similar reductions in DeMeester symptom scores and EAE were reported at 6 weeks. 18 …”

Section: Resultsmentioning

confidence: 69%

Review of antireflux procedures for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Hillman

Yadlapati

Whitsett

et al. 2017

Diseases of the Esophagus

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Introduction Up to 40% of patients with gastroesophageal reflux disease (GERD) report persistent symptoms despite proton pump inhibitor (PPI) therapy. This review outlines the evidence for surgical and endoscopic therapies for the treatment of PPI non-responsive GERD. Material and Methods A literature search for GERD therapies from 2005–2015 in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified unique 2928 citations. Of those, 45 unique articles specific to surgical and endoscopic therapies for PPI non-responsive GERD were reviewed. Results Laparoscopic fundoplication (n=19) provides symptomatic and physiologic relief out to 10 years, though efficacy wanes with time. Magnetic sphincter augmentation (n=6) and transoral incisionless fundoplication (n=9) improve symptoms in PPI non-responders, and may offer fewer side effects than fundoplication, though long-term follow-up is lacking. Radiofrequency energy delivery (n=8) has insufficient evidence for routine use in treating PPI non-responsive GERD. Electrical stimulator implantation (n=1) and endoscopic mucosal surgery (n=2) are emerging therapies for the treatment of GERD. Discussion Laparoscopic fundoplication remains the most proven therapeutic approach. Newer anti-reflux procedures such as magnetic sphincter augmentation and transoral incisionless fundoplication offer alternatives with varying degrees of success, durability, and side effect profiles that may better suit individual patients. Larger head-to-head comparison trials are needed to better characterize the difference in symptom response and side effect profiles.

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Section: Resultsmentioning

confidence: 69%

Review of antireflux procedures for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Hillman

Yadlapati

Whitsett

et al. 2017

Diseases of the Esophagus

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“…Various randomized controlled studies have shown no impact of dividing the short gastric vessels on postoperative dysphagia rates [28–33]. Moreover, increased length of surgery and a higher incidence of postoperative bloating have been described for patients that underwent division of the short gastric vessels on principle [34–36]. In our series, the short gastric vessels were left intact, where the construction of a tension-free wrap was possible.…”

Section: Discussionmentioning

confidence: 86%

Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

et al. 2018

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“…Although no study has formally implicated division of short gastric vessels as a risk factor for delayed gastric empting, several randomized trials and meta‐analyses have found that routine division of short gastric vessels during laparoscopic fundoplication is associated with higher rates of postprandial bloating22, 23, 24, which may reflect delayed gastric emptying. Despite the rationale that division of short gastric vessels may facilitate the creation of a tension‐free fundoplication and minimize the risk of postoperative dysphagia25, multiple studies26, 27, 28, 29 have demonstrated that this intraoperative manoeuvre does not influence swallowing outcomes after antireflux surgery.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

et al. 2017

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BackgroundDelayed gastric emptying can complicate surgery for hiatus hernia. The aim of this study was to quantify its incidence following laparoscopic repair of very large hiatus hernias, identify key risk factors for its occurrence and determine its impact on clinical outcomes.MethodsData collected from a randomized trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (more than 50 per cent of stomach in chest) were analysed retrospectively. Delayed gastric emptying was defined as endoscopic evidence of solid food in the stomach after fasting for 6 h at 6 months after surgery.ResultsDelayed gastric emptying occurred in 19 of 102 patients (18·6 per cent). In univariable analysis, type 2 paraoesophageal hernia (relative risk (RR) 3·15, 95 per cent c.i. 1·41 to 7·06), concurrent anterior and posterior hiatal repair (RR 2·66, 1·14 to 6·18), hernia sac excision (RR 4·85, 1·65 to 14·24), 270°/360° fundoplication (RR 3·64, 1·72 to 7·68), division of short gastric vessels (RR 6·82, 2·12 to 21·90) and revisional surgery (RR 3·69, 1·73 to 7·87) correlated with delayed gastric emptying. In multivariable analysis, division of short gastric vessels (RR 6·27, 1·85 to 21·26) and revisional surgery (RR 6·19, 1·32 to 28·96) were independently associated with delayed gastric emptying. Delayed gastric emptying correlated with adverse gastrointestinal symptomatology, including higher rates of bloating, nausea, vomiting and anorexia, as well as reduced patient satisfaction with the operation and recovery.ConclusionDelayed gastric emptying following large hiatus hernia repair is common and associated with adverse symptoms and reduced patient satisfaction. Division of short gastric vessels and revisional surgery were independently associated with its occurrence.

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Laparoscopic Antireflux Surgery

Cited by 125 publications

References 38 publications

Review of antireflux procedures for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Review of antireflux procedures for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

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