Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)

Abstract

Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD): results of a consensus development conference Eypasch, E.; Neugebauer, E.; Fischer, F.; Troidl, H.; Study group members AMC, :; van Lanschot, J.J.B. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Abstract Background: Laparoscopic antireflux surgery is currently a growing field in endoscopic surgery. The purpose of the Consensus Development Conference was to summarize the state of the art of laparoscopic antireflux operations in June 1996. Methods: Thirteen internationally known experts in gastroesophageal reflux disease were contacted by the conference organization team and asked to participate in a Consensus Development Conference. Selection of the experts was based on clinical expertise, academic activity, community influence, and geographical location. According to the criteria for technology assessment, the experts had to weigh the current evidence on the basis of published results in the literature. A preconsensus document was prepared and distributed by the conference organization team. During the E.A.E.S. conference, a consensus document was prepared in three phases: closed discussion in the expert group, public discussion during the conference, and final closed discussion by the experts. Results: Consensus statements were achieved on various aspects of gastroesophageal reflux disease and current laparoscopic treatment with respect to indication for operation, technical details of laparoscopic procedures, failure of operative treatment, and complete postoperative follow-up evaluation. The strength of evidence in favor of laparoscopic antireflux procedures was based mainly on type II studies. A majority of the experts (6/10) concluded in an overall assessment that laparoscopic antireflux procedures were better than open procedures. Consensus statement Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD) Results of a Consensus Development Conference Conclusions:Further detailed studies in the future with careful outcome assessment are necessary to underline the consensus that laparoscopic antireflux operations can be recommended.

Reflux und Hiatushernie im Spannungsfeld zwischen konservativer und operativer Therapie

“…Die Indikationskriterien zu einer operativen Therapie haben sich in den vergangenen Jahren kaum gewandelt und wurden durch mehrere mono-und multidisziplinäre Konsensusprojekte bestätigt [7,12].…”

Laparoskopische Fundoplikatio

“…Die Einführung der minimal-invasiven Operationstechnik in das Spektrum der chirurgischen Refluxtherapie beeinflusste das Management von Patienten mit gastroösophagealer Refluxkrankheit nachhaltig [1,2,3]. Vor der Einführung der minimal-invasiven Chirurgie hatten die Antirefluxoperationen besonders bei Gastroenterologen eine schlechte Reputation, obwohl die meisten der gegenwär-tig praktizierten modernen Operationsprinzipien und operativen Therapiekonzepte schon während der Zeit der konventionellen Antirefluxchirurgie entwickelt wurde [4,5].…”

“…Für die präoperative Diagnostik ist deswegen als Minimalprogramm zu fordern, dass die Erkrankung mit der Endoskopie und 24-h-pH-Metrie objektiviert wird [2,3,9]. Zum Ausschluss einer schweren Ösophagusmotilitätsstörung, wie z.…”

“…Das Risiko perioperativer Blutungen bei laparoskopischer Antirefluxchirurgie erscheint gegenüber der Inzidenz bei der konventionellen Chirurgie geringer [2,3,19,28,29].Insbesondere das Risiko einer Milzverletzung bzw. Splenektomie erscheint durch die laparoskopische Technik drastisch reduziert.…”

Technik und Langzeitergebnisse der laparoskopischen Fundoplicatio nach Nissen

“…übermäßigem Gebrauch von monopolarem Strom erklärt worden. Grundsätzlich erscheint das Gesamtrisiko perioperativer Blutungen nach laparoskopischer Antirefluxchirurgie gegenüber den Werten der konventionellen Chirurgie reduziert [23,37]. Insbesondere das Risiko von Milzverletzungen bzw.…”