A multicenter prospective audit to investigate the current management of patients undergoing anti-reflux surgery in the UK: Audit & Review of Anti-Reflux Operations & Workup

Abstract

Background There are a variety of surgical and endoscopic interventions available to treat gastroesophageal reflux disease. There is, however, no consensus on which approach is best. The aim of this national audit is to describe the current variation in the UK clinical practice in relation to anti-reflux surgery (ARS) and to report adherence to available clinical guidelines. Methods This national audit will be conducted at centers across the UK using the secure online web platform ALEA. The study will comprise two parts: a registration questionnaire and a prospective multicenter audit of ARS. All participating centers will be required to complete the registration questionnaire comprising details regarding pre-, peri-, and post-operative care pathways and whether or not these are standardized within each center. Following this, a 12-month multicenter prospective audit will be undertaken to capture data including patient demographics, predominant symptoms, preoperative investigations, surgery indication, intraoperative details, and postoperative outcomes within the first 90 days. Local teams will retain access to their own data to facilitate local quality improvement. The full dataset will be reported at national and international scientific congresses and will contribute to peer-reviewed publications and national quality improvement initiatives. Conclusions This study will identify and explore variation in the processes and outcomes following ARS within the UK using a collaborative cohort methodology. The results generated by this audit will facilitate local and national quality improvement initiatives and generate new possibilities for future research in anti-reflux interventions.

Results of the ARROW survey of anti-reflux practice in the United Kingdom

“… 26 The study protocol was published in Diseases of The Esophagus and provides details of the methodology. 25 We defined GERD according to the Montreal classification as a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. We excluded emergency interventions for giant para-esophageal hernia as these cases do not meet the definition of GERD.…”

“…The final questionnaire consisted of 90 fields per surgeon and 57 fields per institution. 25 Participants were enlisted through AUGIS (Association of Upper Gastrointestinal Surgeons), ROUX group of Upper GI surgical trainees and social media. An online tool ( https://www.aleaclinical.eu ) was adapted and developed to collect data and piloted in three centers prior to launch.…”

“…To address this, a United Kingdom-wide, prospective database was designed to record current practice in ARS for 1 year. 25 As the first step, the current study was designed to survey surgeon opinion regarding pre-, peri- and post-operative practice.…”

Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper

“…Complicated diaphragmatic hernias in unstable patients or those who have signs of strangulation or perforation should be primarily approached through the abdomen, reserving the thoracic approach as a complementary access. Thoracotomy or thoracoscopy may be used, especially in chronic herniation because of the presence of viscero-pleural adhesions and the higher risk of intrathoracic visceral perforation [ 99 – 102 ]. Rarely, a thoraco-abdominal approach for complicated DH has been utilized.…”