Laparoscopic Antireflux Surgery –It’s a Wrap!

Hinder, Ronald A.; Smith, Stephen L.; Klingler, Paul J.; Branton, Susan A.; Floch, Neil R.; Seelig, Matthias H.

doi:10.1159/000018686

Cited by 14 publications

(12 citation statements)

References 20 publications

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“…This evidence corroborates the hypothesis that a surgeon acquiring competence in centers of excellence and keeping abreast with current scientific progress by common posteducational activities can maintain his/her proficiency in a low volume hospital for a professional lifetime [25,35,90].…”

Section: Discussionsupporting

confidence: 79%

Is oncologic surgery in a low-volume district general hospital justified? A critical 24-year audit

Szecsi¹

2004

Eur Surg

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Darf onkologische Chirurgie an regionalen Standardkrankenhäusern vorgenommen werden? Eine kritische 24-Jahres-Bilanz Zusammenfassung. Grundlagen: Eine aktuelle Diskussion thematisiert die Zentralisation onkologischer Chirurgie sowie die Auswirkungen chirurgischer und institutioneller Fallzahlen auf die Ergebnisse, -wobei onkologische Eingriffe an Standardkrankenhäusern mit geringer Fallzahl infragegestellt werden. Methodik: Die Daten von 543 operierten onkologischen Patienten des Zeitraumes 03/78 bis 12/2001 wurden in ein Register eingebracht. Endpunkte waren 30-Tage-Letalität sowie die Rate lokoregionärer Rezidive, des Gesamtüber-lebens, tumorspezifischen Überlebens von Entitätsgruppen und UICC-Stadien sowie krankheitsfreien Überlebens. Die Daten wurden durch Referenzzahlen validiert.Ergebnisse: Nach Abzug von Patienten mit prozeduralem Minimalrisiko betrug die 30-Tage Letalität 11 %, -8,1 % nach Elektiveingriffen und 8 % nach R0-Resektionen. Die Letalität durch chirurgische Komplikationen betrug 0,7 % bzw. 0,8 % und 0,3 %, die Letalität durch Allgemeinkomplikationen 10,3 % (5,1 % kardial, 2,0 % pulmonal und 3,2 % andere) bzw. 7,2 % und 7,6 %. Lokalrezidiv-, Gesamtüberlebens-, tumorspezifische Überlebens-und krankheitsfreie Überlebensraten waren gut bis exzellent.Schlussfolgerungen: Chirurgische Kompetenz konnte in einem Regionalspital mit niedriger Fallzahl aufrechterhalten werden. Die Ergebnisse wurden jedoch durch eine vergleichsweise hohe Letalität infolge Allgemeinkomplikationen beeinträchtigt, was die Bedeutung von Risikoevaluierung und institutioneller interdisziplinärer Infrastruktur unterstreicht. Es bietet sich somit eine Strategie selektiver Zentralisation an. Häufige onkologische Erkrankungen mit akzeptabler Begleitmorbidität können mit gleichwertigen Ergebnissen an Regionalspitälern behandelt werden, die sich somit für ihre Integration in den Verbund kooperierender virtueller Regionalzentren qualifizieren.Schlüsselwörter: Onkologische Chirurgie, "low volume"-Krankenhäuser, chirurgische Ergebnisqualität, 30-Tage Letalität, Strukturqualität.Summary. Background: An ongoing discussion focusses on centralization of oncologic surgery and effects of surgical and institutional volumes on outcome, -questioning if oncologic surgery in low volume district general hospitals is justified.Methods: Data of 543 patients undergoing surgery for various cancer entities from 03/1978 until 12/2001 were entered in a prospectively maintained database. Endpoints were 30-day mortality (30 DM), the rate of locoregional recurrence (LR), overall survival (OAS), cause-specific survival (CSS) of entity-and UICC-stage-groups and disease-free survival (DFS). Data were benchmarked.Results: After censoring patients undergoing minimalrisk surgery, 30 DM comprised 11 % for all patients, -8.1 % for patients after elective surgery and 8 % after R0-resection. 30 DM caused by surgical complications was 0.7 %, 0.8 % and 0.3 %, respectively, 30 DM caused by medical causes 10.3 % (cardiac in 5.1 %, pulmonary in 2.0 % and other causes in 3.2 ...

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Section: Discussionsupporting

confidence: 79%

Is oncologic surgery in a low-volume district general hospital justified? A critical 24-year audit

Szecsi¹

2004

Eur Surg

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“…29 Moreover, the magnitude of the basal LES tone after antireflux surgery, which is associated with obstructive symptoms, is related to the level of experience of the laparoscopic surgeon. 30 It is therefore interesting to note that both our study groups had fairly similar basal LES pressure when studied continuously over a certain time period by use of a sleeve-recording device. 9 However, the nadir pressures reached during repeated water swallows attained a value lower than 2 mmHg in patients having an anterior partial fundoplication.…”

Section: Discussionmentioning

confidence: 69%

“…A pressure level that does not fall below 2 mmHg, is essential to prevent free reflux, a fairly common reflux mechanism in patients with severe, complicated reflux disease 29 . Moreover, the magnitude of the basal LES tone after antireflux surgery, which is associated with obstructive symptoms, is related to the level of experience of the laparoscopic surgeon 30 . It is therefore interesting to note that both our study groups had fairly similar basal LES pressure when studied continuously over a certain time period by use of a sleeve‐recording device 9 .…”

Section: Discussionmentioning

confidence: 78%

Manometric characteristics of the gastroesophageal junction after anterior versus posterior partial fundoplication

Engström¹,

Ruth

Lönroth³

et al. 2005

Diseases of the Esophagus

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How best to surgically treat GERD is an unresolved issue. To increase our insights into the fundoplication procedures, functional consequences for the gastroesophageal junction of an anterior or a posterior partial fundoplication were studied by manometry. Patients were randomly selected from a larger study in a randomised comparison between posterior and anterior partial fundoplications. The manometric studies were done 12 months after respective procedures in 24 patients. The motor characteristics of the esophagus and lower esophageal sphincter (LES) function were determined by use of sleeve catheter manometry. The manometric characteristics of the esophageal body were similar in the study groups except for the ramp pressure. This was significantly higher in patients with posterior partial fundoplications. The posterior group had significantly longer total length (P < 0.02) as well as longer intra-abdominal portions (P = 0.07) of the LES while the basal tone, albeit numerically higher, did not reach statistical significance. Water-swallow induced LES relaxations reached lower nadir values in the anterior group (1.7 vs 2.7 mmHg). Gas distension triggered few transient LES relaxations in both study groups while common cavities were more frequently observed in those having an anterior partial wrap (P < 0.01). A posterior partial fundoplication is followed by manometric characteristics suggesting a well functioning antireflux barrier with some obstruction to bolus passage as well as restricted venting of air from the stomach. The manometric mechanisms behind the inferior reflux control achieved by a Watson type of anterior partial wrap has now been further elucidated.

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“…To date, however, there is scant evidence to show that treating GERD can prevent Barrett esophagus, a premalignant condition. 12,13 Once treatment is discontinued, symptoms frequently recur. 14,15 Because relapse is common if therapy is decreased or discontinued, GERD should be considered a chronic condition akin to hypertension, osteoporosis, or hyperlipidemia.…”

Section: Treatment Rationalementioning

confidence: 99%