Late Evaluation of Patients Operated for Gastroesophageal Reflux Disease by Nissen Fundoplication

Abstract

Background: Surgical treatment of GERD by Nissen fundoplication is effective and safe, providing good results in the control of the disease. However, some authors have questioned the efficacy of this procedure and few studies on the long-term outcomes are available in the literature, especially in Brazil. Aim: To evaluate patients operated for gastro-esophageal reflux disease, for at least 10 years, by Nissen fundoplication. Methods: Thirty-two patients were interviewed and underwent upper digestive endoscopy, esophageal manometry, 24 h pH monitoring and barium esophagogram, before and after Nissen fundoplication. Results: Most patients were asymptomatic, satisfied with the result of surgery (87.5%) 10 years after operation, due to better symptom control compared with preoperative and, would do it again (84.38%). However, 62.5% were in use of some type of anti-reflux drugs. The manometry revealed lower esophageal sphincter with a mean pressure of 11.7 cm H2O and an average length of 2.85 cm. The average DeMeester index in pH monitoring was 11.47. The endoscopy revealed that most patients had a normal result (58.06%) or mild esophagitis (35.48%). Barium swallow revealed mild esophageal dilatation in 25,80% and hiatal hernia in 12.9% of cases. Conclusion: After at least a decade, most patients were satisfied with the operation, asymptomatic or had milder symptoms of GERD, being better and with easier control, compared to the preoperative period. Nevertheless, a considerable percentage still employed anti-reflux medications.

Quality of Life After Vertical Gastrectomy Evaluated by the Baros Questionnaire

“…To combat this disease, clinical treatment is the first approach and contemplates the implementation of special diets, psychotherapy, physical activity and pharmacotherapy 18 . However, clinical therapy for obesity, especially for severe obesity (BMI greater than 35 kg/m²), has limited short-term success and almost non-existent in the long term compared to surgical treatment 19 , 27 , 28 .…”

Pre and Postoperative Ph Monitoring and Weight Loss Analysis in Patients Undergoing Gastric Plication in Association With Fundoplication

“…This technique proved to be superior when compared to partial fundoplication. The advantages of Nissen surgery are lower dysphagia 25 , hiatal hernia and esophagitis index, and the increase of lower esophageal sphincter pressure. It is also been reported weight loss of approximately 4 kg in three months, and no trend to regain weight in the 1 st year after surgery, which was probably due to early satiety described by some patients 8 , 20 .…”