Laparoscopic Antireflux Surgery: Were Old Questions Answered? Partial or Total Fundoplication?

Abstract

Laparoscopic total fundoplication is currently considered the gold standard for the surgical treatment of gastroesophageal reflux disease. Short-term outcomes after laparoscopic total fundoplication are excellent, with fast recovery and minimal perioperative morbidity. The symptom relief and reflux control are achieved in about 80 to 90% of patients 10 years after surgery. However, a small but clinically relevant incidence of postoperative dysphagia and gas-related symptoms is reported. Debate still exists about the best antireflux operation; during the last three decades, the surgical outcome of laparoscopic partial fundoplication (anterior or posterior) were compared to those achieved after a laparoscopic total fundoplication. The laparoscopic partial fundoplication, either anterior (180°) or posterior, should be performed only in patients with gastroesophageal reflux disease secondary to scleroderma and impaired esophageal motility, since the laparoscopic total fundoplication would impair esophageal emptying and cause dysphagia.

Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux Disease: Effective, but Postoperative Dysphagia and Risk of Erosion Should Not Be Underestimated. A Systematic Review and Meta-Analysis

“…A total of 22 studies comprising 4,663 patients with MSA device were included in the analysis. Mean age was 52.6 (39.3–64.3) years, 53% were males, and mean BMI was 27.2 (23.9–29.8) kg/m 2 . Mean operative time was 62.4 (43.2–81) minutes; 30-day overall morbidity rate was 0.7% and no mortality was reported.…”

“…Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents into the esophagus causes troublesome symptoms or complications 53 . GERD is the most prevalent gastrointestinal disorder across the United States, ranging from 6 to 30%, with approximately 110 thousand hospital admissions annually 2 , 21 , 51 . Current evidence suggests that its incidence is increasing, mainly due to the rising prevalence of obesity worldwide 35 .…”

“…The laparoscopic fundoplication has been the most common surgical procedure to treat GERD in the last decades 2 , 24 , 37 . In 2008, a multicenter study described a novel laparoscopically implantable magnetic sphincter augmentation (MSA) device designed to restore the lower esophageal sphincter barrier function 13 .…”