NISSEN FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX DISEASE: The ‘Rossetti’ modification of the Nissen fundoplication – technique and results

Rossetti, M; Liebermann-Meffert, D.; Brauer, Robert B.

doi:10.1093/dote/9.4.251

Cited by 17 publications

(12 citation statements)

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“…The classic surgical treatment for gastroesophageal reflux, Nissen's fundoplication or its modifications, presents a clinical recurrence rate close to an average of 10% (range 5–15%). Based on our experience, and in agreement with other groups, this recurrence rate significantly increases as the length of follow‐up increases, especially in the group of patients with long‐segment Barrett's esophagus, with or without the complication of ulcer or stricture, among whom it can reach 60% when assessed by endoscopic and histological evaluation 10 years after surgery 1–9 . Thus, it is relevant to determine in which patients and after which type of surgical technique this recurrence is more frequent and what are the surgical alternatives to be offered to such patients.…”

Section: Introductionsupporting

confidence: 81%

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

Braghetto¹,

Csendes²,

Burdiles³

et al. 2002

Diseases of the Esophagus

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The rate of recurrence of reflux esophagitis after classic antireflux surgery (fundoplication) is 10-15%. This rate is different in patients with esophagitis with and without Barrett's esophagus. We evaluated the clinical and laboratory findings in 104 patients with postoperative recurrent reflux esophagitis, determining the results of repeat antireflux surgery or an acid suppression-bile diversion procedure. Repeat fundoplication was performed in 26 patients, and truncal vagotomy, antrectomy, and Roux-en-Y gastrojejunostomy in 78 patients. Esophagectomy as a third operation was performed in seven patients. After repeat antireflux surgery, endoscopic evaluation demonstrated improvement of esophagitis in a small proportion of patients. Barrett's esophagus remained unchanged, and no regression of ulcer or stricture was observed. These complications improved significantly after acid suppression-bile diversion surgery. Incompetent lower esophageal sphincter (LES) was present in 55.8% after initial surgery and in 23% after reoperation. Acid reflux, initially present in 94.6% of patients, was also observed in 93.6% after fundoplication, 68.8% after redo fundoplication, and 16.6% after treatment with the acid suppression-bile diversion technique. A positive Bilitec test was present in 78% of patients before the operation and 56.6% after the repeat operation, and was negative after bile diversion surgery. Among 13 patients (50%) submitted to repeat surgery alone, esophagectomy as a third operation was necessary as a result of severe non-dilatable stricture in seven patients. Our conclusions are that repeat antireflux surgery alone failed to improve Barrett's esophagus complications and that the best results were obtained in patients submitted to acid suppression-bile diversion surgery.

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Section: Introductionsupporting

confidence: 81%

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

Braghetto¹,

Csendes²,

Burdiles³

et al. 2002

Diseases of the Esophagus

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“…The Rossetti modification of the Nissen fundoplication (15) was performed in all patients, by videolaparoscopic approach, under general anesthesia.…”

Section: Methodsmentioning

confidence: 99%

Surgical treatment of the non-complicated gastroesophageal reflux: fundoplication without division of the short gastric vessels

Felix¹,

Yogi²,

Perini³

et al. 2002

Arq. Gastroenterol.

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-Background -There is today a significant greater number of laparoscopic antireflux procedures for the surgical treatment of gastroesophageal reflux disease and there are yet controversies about the necessity of division of the short gastric vessels and full mobilization of the gastric fundus to perform an adequate fundoplication. Aim -To verify the results of the surgical treatment of non-complicated gastroesophageal reflux disease performing Rossetti modification of the Nissen fundoplication. Patients and Methods -Fourteen patients were operated consecutively and prospectively (mean age 44.07 years); all had erosive esophagitis without Barrett's endoscopic signals (grade 3, Savary-Miller) and they were submitted to the Rossetti modification of the Nissen fundoplication. Endoscopy, esophageal manometry and pHmetry were performed before the procedure and around 18 months postoperatively. Results -There was no morbidity, transient dysphagia average was 18.42 days; there was no register of dehiscence or displacement of the fundoplication and only one patient revealed a light esophagitis at postoperative endoscopy; the others presented a normal endoscopic view of the distal esophagus. All noticed a marked improvement of preoperative symptoms. Lower esophageal sphincter pressure changed from 5.82 mm Hg (preoperative mean) to 12 mm Hg (postoperative mean); lower esophageal sphincter relaxing pressure, from 0.38 mm Hg to 5.24 mm Hg and DeMeester score, from 16.75 to 0.8. Conclusion -Rossetti procedure (fundoplication without division of the short gastric vessels) is an effective surgical method to treat gastroesophageal reflux disease.

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“…In 1946, Nissen performed the first transabdominal reduction for a large and symptomatic paraesophageal hernia. Nissen performed a gastropexy to prevent recurrence (101). This surgical technique was a major advance over the previous transthoracic approach.…”

Section: Impact Of Nazism On Endoscopic Innovations Inmentioning

confidence: 99%

The Effect of Nazism on Medical Progress in Gastroenterology: The Inefficiency of Evil

Cappell

2006

Dig Dis Sci

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While Nazism is almost universally recognized as a great evil, control of science and medicine by the totalitarian Nazi state might be viewed as increasing efficiency. Scientific methods are applied to semiquantitatively analyze the effects of Nazism on medical progress in gastroenterology to document its pernicious effects, and to honor outstanding gastroenterologists persecuted or murdered by the Nazis. This is a retrospective, quasi-case-controlled study. To disprove the null hypothesis that Nazism was efficient, retarded progress in gastroenterology is demonstrated by (1) enumerating the loss to Nazi Germany from 1933 to 1944 due to violent death, incarceration, or forced exile of key researchers in gastroenterology, defined by authorship of at least one book or 10 articles in peer-reviewed journals or other outstanding scholarship; (2) demonstrating a statistically significantly greater loss in Nazi Germany than in non-Nazi (Weimar German Republic from 1921 to 1932) or anti-Nazi (democratic America from 1933 to 1944) control groups; and (3) demonstrating that each loss was directly due to Nazism (murder, incarceration, or exile due to documented threat of violence/death or revocation of medical license). Sources of error in analyzing events from 70 years ago are described. Nazi Germany and Nazi-occupied Europe gained 0 and lost 53 key gastroenterology researchers, including 32 lost due to forced exile, 11 murdered by the Nazis, 5 lost due to suicide under threat of violence, 3 in hiding from the Gestapo, and 2 for other reasons. Fifty-two of the gastroenterologists were persecuted solely because they were Jewish or of Jewish descent and one because he was a Christian anti-Nazi Polish patriot. Particularly severe losses occurred in endoscopy. The loss in Nazi Germany from 1933 to 1944 was significantly greater than that in non-Nazi Germany and Austria from 1921 to 1932 (53 versus 4; odds ratio = 25.27; 95% CI: 9.01-70.48; P < 0.0001) and was significantly greater than that in anti-Nazi America from 1933 to 1944 (53 versus 0; odds ratio > 104.0; 95% CI: 17.62-608.95; P < 0.0001). Lost physicians in Nazi Germany (with reasons for loss) included Ismar Boas, the father of modern gastroenterology (suicide after medical license revoked); Hans Popper, the father of hepatopathology (fled impending arrest); Rudolph Nissen, the father of antireflux surgery (fled after job dismissal); Rudolph Schindler, the father of semiflexible endoscopy (fled after incarceration); Heinrich Lamm, the first to experimentally demonstrate fiberoptic transmission and the first to suggest its applicability for gastroscopy (fled after medical license revoked); Hermann Strauss, a pioneer in rigid sigmoidoscopy (suicide in a concentration camp); A.A.H. van den Bergh, who discovered the van den Bergh reaction to differentiate indirect from direct bilirubin (died in hiding in Nazi-occupied Holland); and Kurt Isselbacher, subsequently the Chief of Gastroenterology at Harvard Medical School (fled in childhood after a grandfather murdered by Nazis...

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NISSEN FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX DISEASE: The ‘Rossetti’ modification of the Nissen fundoplication – technique and results

Cited by 17 publications

References 0 publications

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

Results of surgical treatment for recurrent postoperative gastroesophageal reflux

Surgical treatment of the non-complicated gastroesophageal reflux: fundoplication without division of the short gastric vessels

The Effect of Nazism on Medical Progress in Gastroenterology: The Inefficiency of Evil

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