Prospective, randomized trial of bipolar electrosurgery vs ultrasonic coagulation for division of short gastric vessels during laparoscopic Nissen fundoplication

Underwood, Robert; Dunnegan, Deanna L.; Soper, Nathaniel J.

doi:10.1007/s004649901094

Cited by 31 publications

(18 citation statements)

References 36 publications

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“…In the first 2 trials the ultrasonic scalpel was compared with multifire clip applier, 66,67 whereas in the last trial, 68 it was compared with bipolar coagulating forceps. The details and results of these trials are shown in Table 9.…”

Section: Catarci Et Almentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

280

178

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Objective: To highlight the current available evidence in antireflux surgery through a systematic review of randomized controlled trials (RCTs). Summary Background Data: Laparoscopic fundoplication is currently suggested as the gold standard for the surgical treatment of gastroesophageal reflux disease, but many controversies are still open concerning the influence of some technical details on its results. Methods: Papers related to RCTs identified via a systematic literature search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes were abstracted and summarized across studies. Defined outcomes were examined for 41 papers published from 1974 to 2002 related to 25 RCTs. A meta-analysis was performed pooling the results as odds ratios (OR), rate differences (RD), and number needed to treat (NNT). Data given as mean and/or median values were pooled as a mean Ϯ SD (SD). Results: No perioperative deaths were found in any of the RCTs. Immediate results showed a significantly lower operative morbidity rate (10.3% versus 26.7%, OR 0.33, RD Ϫ12%, NNT 8), shorter postoperative stay (3.1 versus 5.2 days, P ϭ 0.03), and shorter sick leave (20.1 versus 35.8 days, P ϭ 0.03) for laparoscopic versus open fundoplication. No significant differences were found regarding the incidence of recurrence, dysphagia, bloating, and reoperation for failure at midterm follow-up. No significant differences in operative morbidity (13.1% versus 9.4%) and in operative time (90.2 versus 84.2 minutes) were found in partial versus total fundoplication. A significantly lower incidence of reoperation for failure (1.6% versus 9.6%, OR 0.21, RD Ϫ7%, NNT 14) was found after partial fundoplication, with no significant differences regarding the incidence of recurrence and/or dysphagia. Routine division of short gastric vessels during total fundoplication showed no significant advantages regarding the incidence of postoperative dysphagia and recurrence when compared with no division. The use of ultrasonic scalpel compared with clips or bipolar cautery for the division of short gastric vessels showed no significant effect on operative time, postoperative complications, and costs. Conclusions: Laparoscopic antireflux surgery is at least as safe and as effective as its open counterpart, with reduced morbidity, shortened postoperative stay, and sick leave. Partial fundoplication significantly reduces the risk of reoperations for failure over total fundoplication. Routine versus no division of short gastric vessels showed no significant advantages. A word of caution is needed when implementing these results derived from RCTs performed in specialized centers into everyday clinical practice, where experience and skills may be suboptimal.

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Section: Catarci Et Almentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

280

178

View full text Add to dashboard Cite

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“…The use of an ultrasonic scalpel in laparoscopic surgery is progressively advocated for several reasons [12][13][14][15]. Coagulation of vascular structures is easy and safe with the ultrasonic scalpel, and there is no effect on pacemaker function, which is a major drawback of electrocautery.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal transforming growth factor beta-1 expression during laparoscopic surgery: a clinical trial

et al. 2007

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Background: Transforming growth factor-beta 1 (TGFb1) is a growth factor involved in various biologic processes, including peritoneal wound healing and dissemination of malignancies. Laparoscopic surgery is evolving rapidly, and indications are increasing. The peritoneal TGF-b1 expression during laparoscopic surgery is unknown. Methods: For this study, 50 patients scheduled for laparoscopic cholecystectomy were randomized into five groups, then surgically treated with various pressures, light intensities, and dissection devices. Peritoneal biopsies were taken at the beginning and end of surgery. Tissue concentrations of total and active TGF-b1 were measured using enzyme-linked immunosorbent assay (ELISA) techniques. Results: There was no significant difference in either total or active TGF-b1 concentration between peritoneal biopsies taken at the start of surgery and samples taken at the end of the procedure. Patients who underwent surgery with the ultrasonic scalpel had significant lower levels of both active (p < 0.005) and total (p < 0.01) TGF-b1 at the end of surgery than patients treated with electrocautery. Patients who had surgery with a high light intensity had significantly lower levels of total TGF-b1 levels (p < 0.005) with an unchanged active part than patients who had surgery with low light intensity. Conclusion: The choice of dissection device and the light intensity used in laparoscopic surgery affect peritoneal TGF-b1 concentrations, indicating that peritoneal biology can be affected by laparoscopic surgery. Because TGF-b1 is involved in various biologic processes in the peritoneal cavity, this observation may have important clinical consequences.

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“…The use of harmonic scalpel for SGV division has been advocated to be better than with the use of staples 25,26 . Another study compared the harmonic scalpel with the bipolar electrocautery and found no signifi cant difference comparing intra and immediate postoperative aspects 27 . Despite the fact that we used the harmonic scalpel for SGV division in every procedure, this group had higher procedure duration.…”

Section: Discussionmentioning

confidence: 99%

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

et al. 2007

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PURPOSE: Evaluate short results after fundoplication procedure, concerning the division of short gastric vessels. METHODS: A prospective randomization of 90 patients with indication for hiatoplasty and total fundoplication with fundus mobilization was performed. They were divided into two groups: no SGV division (group A, n= 46) and with SGV division (Group B, n=44), although in both groups the gastric fundus was mobilized to perform a floppy valve. Early outcome with clinical follow up (1 year) was observed. RESULTS: Both groups were similar regarding preoperative parameters and severity of gastroesophageal reflux disease (GERD). No difference in morbidity was observed during hospital stay. Nevertheless, the median operating time was 80,2 minutes in group A and 94,1 minutes (p=0,021) in Group B. Transitory dysphagia during the first year was significantly lower in group B (46,6% versus 23,2%, p=0,012). However, in 12 months clinical outcome was similar in both groups (clinical symptoms of GERD, persistent dysphagia and reoperations). CONCLUSION: There was no improvement in routine division of SGV in total fundoplication procedure when the gastric fundus was mobilized.

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Prospective, randomized trial of bipolar electrosurgery vs ultrasonic coagulation for division of short gastric vessels during laparoscopic Nissen fundoplication

Cited by 31 publications

References 36 publications

Evidence-Based Appraisal of Antireflux Fundoplication

Evidence-Based Appraisal of Antireflux Fundoplication

Peritoneal transforming growth factor beta-1 expression during laparoscopic surgery: a clinical trial

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

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