Causes of dissatisfaction after laparoscopic fundoplication: the impact of new symptoms, recurrent symptoms, and the patient experience

Humphries, Leigh Ann; Hernandez, Jonathan M.; Clark, W. Edwin; Luberice, Kenneth; Ross, Sharona; Rosemurgy, Alexander S.

doi:10.1007/s00464-012-2611-y

Cited by 57 publications

(42 citation statements)

References 38 publications

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“…Severe and persistent postoperative dysphagia after LTF is the main cause of reoperations in GERD´s surgical treatment, posing a major concern for the enthusiasts of this type of treatment (2,12,17) The proper investigation of this complication is mandatory for the adequate selection of the treatment. Well-positioned valves, without evidences of structural defects, can be adequately treated with endoscopic dilation as a first choice; nonetheless, patients with twisted, migrated or anatomically disrupted fundoplications rarely respond satisfactorily to endoscopic treatment and should be taken to early surgical correction (5) .…”

Section: Discussionmentioning

confidence: 99%

“…It provides good control of gastroesophageal reflux in the medium and long term (6,7,19,21) . However, the surgical approach of GERD is associated with several adverse effects, especially gas-bloating and dysphagia, that results in loss of quality of life and great dissatisfaction in significant proportion of patients (2,17) . Several randomized studies and their metaanalyses have demonstrated that routine short gastric vessels (SGV) division is not necessary in LTF and is associated with a greater occurrence of complications.…”

Section: Introductionmentioning

confidence: 99%

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DYSPHAGIA AFTER LAPAROSCOPIC TOTAL FUNDOPLICATION: anterior or posterior gastric wall fundoplication?

Bonadiman

Teixeira

Goldenberg

et al. 2014

Arq. Gastroenterol.

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-Context -The occurrence of severe dysphagia after laparoscopic total fundoplication is currently an important factor associated with loss of quality of life in patients undergoing this modality of treatment for gastroesophageal reflux disease. Objective -Compare the incidence and evaluate the causes of severe postoperative dysphagia in patients undergoing laparoscopic total fundoplication (LTF) without short gastric vessels division, using the anterior gastric wall (Rossetti LTF) or anterior and posterior gastric walls (Nissen LTF). Methods -Analysis of the data of 289 patients submitted to LTF without short gastric vessels division from January 2004 to January 2012, with a minimum follow-up of 6 months. Patients were divided in Group 1 (Rossetti LTF -n = 160) and Group 2 (Nissen LTF -n = 129). Results -The overall incidence of severe postoperative dysphagia was 3.11% (4.37% in group 1 and 1.55% in group 2; P = 0.169). The need for surgical treatment of dysphagia was 2.5% in group 1 and 0.78% in group 2 (P = 0.264). Distortions of the fundoplication were identified as possible causes of the dysphagia in all patients taken to redo fundoplication after Rossetti LTF. No wrap distortion was seen in redo fundoplication after Nissen LTF. Conclusion -The overall incidence of severe postoperative dysphagia did not differ on the reported techniques. Only Rossetti LTF was associated with structural distortion of the fundoplication that could justify the dysphagia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

DYSPHAGIA AFTER LAPAROSCOPIC TOTAL FUNDOPLICATION: anterior or posterior gastric wall fundoplication?

Bonadiman

Teixeira

Goldenberg

et al. 2014

Arq. Gastroenterol.

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“…Among the complications we had one abscess of the abdominal wall, one ischemic stroke, one opening lung pleura (no need drainage) and one prolonged ileus with symptomatic abdominal distention. The mean hospital stay was 3 days 8,9,17,22,28,29,34,37,38 .…”

Section: Perioperative Datamentioning

confidence: 99%

“…Early dysphagia is defined as during the first six weeks after surgery and is a very common postoperative symptom which rarely requires some specific treatment. Persistent dysphagia beyond six weeks has been reported in 3-30% of patients 8,12,17,18,27,28,31,32,38 .…”

Section: Introductionmentioning

confidence: 99%

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Identificação de fatores de risco pré-operatórios para disfagia pós-operatória persistente após cirurgia laparoscópica para doença do refluxo gastroesofágico

Ribeiro

Tercioti-Júnior

Souza-Neto

et al. 2013

ABCD, arq. bras. cir. dig.

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-Background:Postoperative dysphagia is common after antireflux surgery and generally runs a self-limiting course. Nevertheless, part of these patients report long-term dysphagia. Inadequate surgical technique is a well documented cause of this result. Aim: This retrospective study evaluated the preoperative risk factors not surgery-related for persistent dysphagia after primary laparoscopic antireflux surgery. Methods: Patients who underwent laparoscopic antireflux surgery by the modified technique of Nissen were evaluated in the preoperative period retrospectively. Postoperative severity of dysphagia was evaluated prospectively using a stantardized scale. Dysphagia after six weeks were defined as persistent. Statistical tests of association and logistic regression were used to identify risk factors associated with persistent dysphagia. Results: A total of 55 patients underwent primary antireflux surgery by a single surgeon team. Of these, 25 patients had preoperative dysphagia (45,45%). Persistent postoperaive dysphagia was reported by 20 (36,36%). Ten patients (18,18%) required postoperative endoscopic dilatation for dysphagia. There was statistical association between satisfaction with surgery and postoperative dysphagia and requiring the use of antireflux medication after the procedure; and between preoperative dysphagia and postoperative dysphagia. Logistic regression identified significant preopertive dysphagia as risk factor for persistent postoperative dysphagia. No correlations were found with preoperative manometry. Conclusions: Patients with significant preoperative dysphagia were more likely to report persistent postoperative dysphagia. This study confirms that the current manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for post-fundoplication dysphagia. Minucious review of the clinical history about the presence and intensity of preoperative dysphagia is important in the selection of candidates for antireflux surgery. RESUMO -Racional:Disfagia no pós-operatório é comum após a operação anti-refluxo. No entanto, uma parte dos pacientes relatam disfagia persistente, e técnica cirúrgica inadequada é uma causa bem documentada deste resultado. Objetivo: Este estudo retrospectivo avaliou os fatores de risco no pré-operatório para a disfagia persistente após operação antirefluxo por via laparoscópica. Métodos: Pacientes submetidos à operação anti-refluxo por via laparoscópica pela técnica de Nissen modificada foram avaliados no pré-operatório de forma retrospectiva. A severidade da disfagia pós-operatória foi avaliada prospectivamente usando uma escala estabelecida. A disfagia após seis semanas foi definida como persistente. Os testes estatísticos de associação e regressão logística foram utilizados para identificar os fatores de risco associados à disfagia persistente. Resultados: Um total de 55 pacientes foram submetidos ao procedimento por via laparoscópica por uma única equipe de cirurgiões. Destes, 25 doentes referiam disfagia pré-operató...

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Robotic‐assisted versus laparoscopic redo antireflux surgery in children: A cost‐effectiveness study

Delgado-Miguel

Camps

2023

Robotics Computer Surgery

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IntroductionRobotic‐assisted redo fundoplication has some advantages compared to the laparoscopic approach in adults, although to date there are no studies in children.MethodsA retrospective case‐control study was performed among consecutive children who underwent redo antireflux surgery between 2004 and 2020, divided into two groups: LAF group (laparoscopic redo‐fundoplication) and RAF group (robotic‐assisted redo‐fundoplication). Demographics, clinical, intraoperative, postoperative and economic data were compared.ResultsA total of 24 patients were included (10 LAF group; 14 RAF group) without demographic or clinical differences. The RAF group presented lower intraoperative blood loss (52 ± 19 vs. 145 ± 69 mL; p < 0.021), shorter surgery time (135 ± 39 vs. 179 ± 68 min; p = 0.009) and shorter length of hospital stay (median 3 days [2–4] vs. 5 days [3–7]; p = 0.002). The RAF group presented a higher rate of symptom improvement (85.7% vs. 60%; p = 0.192) and lower overall associated economic costs (25 800$ vs. 45 500$; p = 0.012).ConclusionRobotic‐assisted redo antireflux surgery may offer several benefits over the laparoscopic approach. Prospective studies are still needed.

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Causes of dissatisfaction after laparoscopic fundoplication: the impact of new symptoms, recurrent symptoms, and the patient experience

Cited by 57 publications

References 38 publications

DYSPHAGIA AFTER LAPAROSCOPIC TOTAL FUNDOPLICATION: anterior or posterior gastric wall fundoplication?

DYSPHAGIA AFTER LAPAROSCOPIC TOTAL FUNDOPLICATION: anterior or posterior gastric wall fundoplication?

Identificação de fatores de risco pré-operatórios para disfagia pós-operatória persistente após cirurgia laparoscópica para doença do refluxo gastroesofágico

Robotic‐assisted versus laparoscopic redo antireflux surgery in children: A cost‐effectiveness study

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