Evaluation and management of patients with symptoms after anti-reflux surgery

Lin, David C.; Chun, Carlene L.; Triadafilopoulos, George

doi:10.1111/dote.12103

Cited by 27 publications

(8 citation statements)

References 76 publications

(86 reference statements)

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“…The causes of persistent symptoms after surgery remain unclear. Non-GERD symptoms might be due to increased esophageal sensitivity while other symptoms (like bloating, early satiety and nausea) may be unmasked when reflux symptoms improve [79–81]. A careful selection of patients and thorough follow-up is needed to avoid unnecessary acid suppression in post-surgical patients.…”

Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

341

288

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BackgroundThe introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.MethodsThe topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.ResultsTwenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger–Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.ConclusionsOverall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based ...

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Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

341

288

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“…), inducing a constant professional debate [18][19][20] . Due to a high relapse rate of larger HH with direct suturing of the hiatal defect, it was recommended to apply a prosthesis, especially in cases with an excessively large hiatal defects in order to reduce tension at the crural suture site and produce stronger scar tissue by an incorporated mesh 18,21 . Following the first insertion of a mesh for a hiatal closure reported in 1993, numerous techniques of prosthesis insertion were applied with the aim to reduce the relapse rate 22 .…”

Section: Discussionmentioning

confidence: 99%

“…The application of prosthetic materials could induce unpleasant postoperative complications, such as esophageal strictures, mesh migrations, and visceral erosions. To prevent prosthetic migrations, crural approximation was recommended whenever possible, followed by an onlay mesh in-stallation to reinforce the hiatal defect and prevent intrathoracic fundoplication migrations 21,23 .…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of hiatal hernia: A ten-year experience

et al. 2018

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Background/Aim. Today, hiatal hernia and the accompanying gastroesophageal reflux disease (GERD) are the most common benign disorders of the upper gastrointestinal tract. The aim of this study was to present the results of the hiatal hernia and GERD laparoscopic surgery in finding out for best type of fundoplication in each individual case. Methods. The study included 132 patients with the diagnosis of hiatal hernia and GERD, operated in the period from May 2004 to December 2014 at the Clinic for Abdominal, Endocrine and Transplantation Surgery of the Clinical Center Vojvodina, Serbia. The patients were selected for surgery on the basis of the findings of esophago-gastroscopy, barium contrast upper gastrointestinal series, 24-hour pH monitoring and esophageal manometric studies. Results. All the patients in this series underwent a posterior hiatoplasty with direct sutures. An additional mesh reinforcement was performed in 21 (16%) patients with a large hiatal hernia. There were 68 Nissen, 59 Toupet, and 5 Door fundoplications. Recently, the short-floppy Nissen fundoplication has predominantly been performed due to good postoperative outcomes. Intraoperative complications were: the parietal pleura lesion (3 patients), the spleen capsule laceration (4 patients), a minor injury of the adventitia of the distal esophagus (1 patient) and a thermal injury of the gastric fundus (1 patient). The postoperative complications were as folows: one fistula of the gastric fundus, transitory subcutaneous emphysema in the neck (5 patients), minor left-sided pleural effusions (6 patients), a transitory dysphagia (23 patients). The overall recurrence rate was 18.2% (24 patients). There was one fatal outcome. Conclusion. Laparoscopic surgery is considered a safe and effective surgical procedure for the treatment of hiatal hernia. The hiatal repair with a mesh reinforcement is recommended in selected cases. Today all consider the "short floppy" Nissen fundoplication as procedure of choice for the adequate hiatal repair.

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“…Complications of fundoplication include dysphagia from a wrap that is too tight, retching, gas bloat syndrome, breakdown of the wrap, hiatal herniation, slipped wrap, and recurrence of reflux. 18,23,36,37 Recurrence of GERD is <10 to 20%. 2 Risk factors for recurrence include younger age at the time of surgery, presence of a preoperative hiatal hernia, postoperative retching, and the need for postoperative esophageal dilations.…”

Section: Redo Fundoplicationmentioning

confidence: 99%

Laparoscopic Fundoplication for the Surgical Management of Gastroesophageal Reflux Disease in Children

Dekonenko

Holcomb

2020

Eur J Pediatr Surg

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Gastroesophageal reflux (GER) is common in infants generally resolving in early childhood. However, gastroesophageal reflux disease (GERD) is diagnosed when persistent troublesome symptoms and/or complications of GER develop. These symptoms and complications can significantly affect the quality of life, thus requiring medical or surgical treatment. Medical management is typically trialed, but operative treatment is indicated with severe symptoms such as aspiration pneumonia, apneic episodes, bradycardia, apparent life-threatening events, severe vomiting, failure to thrive, esophagitis, stricture, and failed medical therapy. We review the recent literature on the indications and outcomes for laparoscopic fundoplication in the management of pediatric GERD.

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Evaluation and management of patients with symptoms after anti-reflux surgery

Cited by 27 publications

References 76 publications

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Surgical treatment of hiatal hernia: A ten-year experience

Laparoscopic Fundoplication for the Surgical Management of Gastroesophageal Reflux Disease in Children

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