Predictive factors for short gastric vessels division during laparoscopic total fundoplication

Teixeira, Alexandre Chartuni Pereira; Herbella, Fernando A. M.; Bonadiman, Adorísio; Farah, José Francisco de Mattos; Grande, José Carlos Del

doi:10.1590/0100-69912015003005

Cited by 5 publications

(4 citation statements)

References 20 publications

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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. Therefore, some surgeons no longer routinely divide the short gastric vessels30, 31, 32.…”

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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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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“…[ 14 , 15 , 19 ] However, multiple randomized prospective studies have shown no impact of this intraoperative modification in the reduction of the above mentioned adverse effect. [ 16 – 18 , 22 , 39 , 40 ] Moreover, a higher incidence of postoperative bloating, re-herniation and longer operating time has been described in patients that underwent the additional modification of the NF. [ 20 , 23 – 25 ] Our results are similar to previous literature showing no difference in postoperative dysphagia rates in patients with and those without division of the SGV (6 groups A + B vs. 5 groups B + C, p = 0.873).…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] Although it has been claimed that dividing the SGV may minimize the risk of dysphagia [19], different studies failed to demonstrate both short and long-term benefits for patients that underwent this maneuver. [17,18,[20][21][22] Moreover, some trials have reported a higher incidence of abdominal bloating and recurrent hiatal hernia as well as increased operating time including division of the SGV. [23][24][25] Furthermore, added posterior gastropexy aimed to reduce the re-herniation rate and lengthen the intraabdominal esophagus.…”

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confidence: 99%

Additional fundophrenicopexia, after Nissen fundoplication, reduces postoperative dysphagia and re-operation rate in the long-term follow up

et al. 2021

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Background Various technical modifications of Nissen fundoplication (NF) that aim to improve patients’ outcomes have been discussed. This study aims to evaluate the effect of division of the short gastric vessels (SGV) and the addition of a standardized fundophrenicopexia on the postoperative outcome after NF. Methods 283 consecutive patients with GERD treated with NF were divided into four groups following consecutive time periods: with division of the SGV and without fundophrenicopexia (group A), with division of the SGV and with fundophrenicopexia (group B), without division of the SGV and with fundophrenicopexia (group C) and without division of the SGV and without fundophrenicopexia (group D). Postoperative contrast swallow, dysphagia scoring, GEDR-HRQL and proton pump inhibitor intake were evaluated. A comparative analysis of patients with division of the SGV and those without (161 A + B vs. 122 C + D), and patients with fundophrenicopexia and those without (78 A vs. 83 B and 49 C vs. 73 D) was performed. Results Fundophrenicopexia reduced postoperative dysphagia rates (0 group C vs. 5 group D, p = 0.021) in patients where the SGV were preserved and reoperation rates (1 group B vs. 7 group A, p = 0.017) in patients where the SGV were divided. There was no significant difference in the postoperative rates of heartburn relief, dysphagia, gas bloating syndrome, interventions, re-fundoplication and the GERD-HRQL score between groups A + B and C + D, respectively. Conclusion Standardized additional fundophrenicopexia in patients undergoing Nissen fundoplication significantly reduces postoperative dysphagia in patients without division of the SGV and reoperation rates in patients with division of the SGV. Division of the SGV has no influence on the postoperative outcome of NF.

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“…[19][20][21]23,43 Further randomized controlled trials in which SGVs were divided have shown no impact on PD rates. [44][45][46][47][48][49] How then to interpret our data which, with a statistically significant difference, document a lower incidence of persistent dysphagia in the group of patients undergoing FNF? The difference between NRF and FNF techniques is not limited to the division of SGVs.…”

Section: Discussionmentioning

confidence: 99%

Complete Fundus Mobilization Reduces Dysphagia After Nissen Procedure

Renzi

Sarno²,

D’Aniello³

et al. 2020

Surg Innov

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Background. Anti-reflux surgery is an effective treatment for gastroesophageal reflux disease (GERD). Nevertheless, surgery is still indicated with great caution in relation to the risk of complications, and in particular to postoperative dysphagia (PD). Objective. To compare the clinical outcomes, with particular focus on the incidence and severity of PD, of laparoscopic Nissen–Rossetti fundoplication (NRF) and floppy Nissen fundoplication (FNF) with complete fundus mobilization, in the surgical treatment of GERD. Methods. Ninety patients with GERD were enrolled. Forty-four patients (21[47.7%] men, 23[52.2%] women; mean age 42.4 ± 14.3 years) underwent NRF (Group A), and 46 patients (23[50%] men, 23[50%] women; mean age 43.3 ± 15.4 years) received laparoscopic FNF with complete fundus mobilization (Group B). Clinical assessment was performed using a structured questionnaire and SF-36 quality of life (QoL) score. PD was assessed using a validated classification, and an overall outcome was also determined by asking the patient to score it. Results. At 24-month follow-up, 38 (88.3%) patients in Group A vs 39 (86.6%) in Group B reported to be completely satisfied with reflux relief and free of protonic pump inhibitors (PPIs), while 3 (6.9%) in Group A vs 2(4.4%) in Group B reported occasional PPI intake and 2(4.6%) in Group A vs 4(8.8%) in Group B needed regular PPI use. Persistent PD was observed in 8(18.6%) patients in Group A and in 2(4.4%) in Group B ( P = .03). No significant differences were found in the QoL score and in the overall outcome perceived by the patients. Conclusion. FNF, with complete fundus mobilization, appears to be associated with a lower rate of postoperative persistent dysphagia.

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Predictive factors for short gastric vessels division during laparoscopic total fundoplication

Abstract: the division of the short gastric vessels is not required routinely, but male gender and grade IV-V esophagitis are independent predictors of the need for section of these vessels.

Cited by 5 publications

References 20 publications

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

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

Additional fundophrenicopexia, after Nissen fundoplication, reduces postoperative dysphagia and re-operation rate in the long-term follow up

Complete Fundus Mobilization Reduces Dysphagia After Nissen Procedure

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