Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

Du, Xiaohong; Wu, Ji-Min; Hu, Zhiwei; Wang, Feng; Wang, Zhonggao; Zhang, Chao; Chen, Yan; Chen, Mei‐Ping

doi:10.1097/md.0000000000008085

Cited by 43 publications

(28 citation statements)

References 47 publications

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“…37 Other studies have found similar results. 38,39 In the context of primary RYGB, two studies have indicated that the percentage of patients on PPIs does not change and may even increase after surgery. 40,41 Although the percentage of patients in our study who remained on acidsuppressing medication is higher than that in the aforementioned studies (particularly those assessing primary RYGB), this may be explained by the fact that outcomes of antireflux operations are worse after reoperations than after primary operations.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

Spann

Harrison

English

et al. 2020

The American Surgeon™

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Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m2 at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

Spann

Harrison

English

et al. 2020

The American Surgeon™

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“…The evidence suggests that there is little difference in post-operative dysphagia when comparing full and partial posterior fundoplication[20] and while the evidence from the randomized trials comparing posterior with anterior fundoplication was mixed. A recent meta-analysis has reported that both anterior and posterior fundoplication are equally effective at controlling reflux symptoms the 180 0 anterior fundoplication is associated with a lower incidence of post-operative dysphagia[21]. As a consequence an anterior fundoplication is associated with fewer re-operations (carried out for dysphagia).…”

Section: Comparison Between Full and Partial Wrapsmentioning

confidence: 99%

Wrap choice during fundoplication

Bramhall¹,

Mourad²

2019

WJG

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Gastro-oesphageal reflux disease is an increasing health burden. The mainstay of treatment has conventionally been medical therapy but since the introduction of laparoscopic surgery laparoscopic anti-reflux surgery has been increasingly used for intractable symptoms or in patients unwilling to take long term medication. The Nissen 360 degree wrap has traditionally been considered the gold standard operation but can be associated with significant complications. These complications include “gas bloat” and dysphagia and can occur relatively frequently. Various modifications have been described to the original operation and some of these have been described. In addition alternative wraps have been described which seem to have a reduced incidence of complications associated with their use. This editorial discusses the various types of wrap that can be performed and the minimum requirements of the surgical technique. The evidence from a recent meta-analysis of the randomised data has suggested that an anterior wrap is associated with a lower rate of complications and gives just as good control of reflux symptoms. The advantages and disadvantages of an anterior wrap are discussed. The lack of long term follow up data concerns some practitioners and at the moment the choice of wrap carried out still rests with the individual surgeon.

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“…180°l aparoscopic anterior fundoplication can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms. The risk of recurrent symptoms should need to be balanced against the risk of dysphagia when surgeons choose surgical procedures for each individual with GERD [16]. More studies have shown that at 1 and 5 years post-surgery, dysphagia and gas-related symptoms are lower after 180°l aparoscopic anterior fundoplication than after laparoscopic Nissen's fundoplication, and esophageal acid exposure and esophagitis are similar, with no differences in heartburn scores, patient satisfaction, dilatations, and reoperation rate.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Anterior 180° Partial Fundoplication - Indian Perspective

et al. 2021

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Aim: To evaluate Laparoscopic anterior 180° partial fundoplication for its good long-term relief forsymptoms of gastroesophageal reflux disease and association with adverse effects. Methods:Study design: Prospectively evaluated case series. Settings: Tertiary care centers Patients: Theclinical outcomes were determined for all patients who had undergone a laparoscopic anterior partialfundoplication by us between January 1, 2013 to March 31, 2021. Interventions: Clinical outcome,complications, and follow-up after laparoscopic anterior 180° partial fundoplication was obtainedusing a structured questionnaire. Results and Discussion: 228 procedures were performed. Theoutcome at 0 to 8 years (mean, 4 years) follow-up was determined for 195 patients. 1 death waslinked to the laparoscopic procedure and 2 patients died during follow-up due to unrelated causes.For 186 patients (95%) with clinical outcome data at late follow-up, gastroesophageal refluxsymptoms were significantly improved following surgery and were well controlled in 9 patients(4.5%). In a subset of 85 patients with more than 5 years of follow-up, relief of heartburn was foundin 59 patients (69%). Incidence and severity of heartburn were reduced after surgery in 22 patients(26%), decreased dyspepsia in 80 patients (94%). Normal belching was preserved in 84 patients(99%) and almost all patients were able to eat normally. Conclusion: Laparoscopic anterior 180°partial fundoplication is an effective procedure for the surgical treatment of gastroesophageal refluxand is associated with a high rate of patient satisfaction at late follow-up. Compared to Nissen'sfundoplication it is as good as control of recurrent reflux as well as reduced adverse effects. Thepatient goes home in 3-4 days. Hence we recommend it as the procedure of choice for refluxsymptoms.

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Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

Cited by 43 publications

References 47 publications

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

Wrap choice during fundoplication

Laparoscopic Anterior 180° Partial Fundoplication - Indian Perspective

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