Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility

Strate, Ursula; Emmermann, A.; Fibbe, Christiane; Layer, Peter; Zornig, C.

doi:10.1007/s00464-007-9546-8

Cited by 188 publications

(166 citation statements)

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“…It has been suggested that manometry could subgroup gastroesophageal reflux disease patients into those requiring partial or total fundoplication treatment [29][30][31] . However, studies have not been able to prove that preoperative manometry could predict postoperative outcome in terms of dysphagia [32][33][34] . Measurement of axial force is more likely to identify patients who would develop postoperative dysphagia, although proof awaits clinical studies.…”

Section: Resultsmentioning

confidence: 99%

Axial force measurement for esophageal function testing

Gravesen¹,

Funch‐Jensen²,

Gregersen³

et al. 2009

WJG

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The esophagus serves to transport food and fluid from the pharynx to the stomach. Manometry has been the "golden standard" for the diagnosis of esophageal motility diseases for many decades. Hence, esophageal function is normally evaluated by means of manometry even though it reflects the squeeze force (force in radial direction) whereas the bolus moves along the length of esophagus in a distal direction. Force measurements in the longitudinal (axial) direction provide a more direct measure of esophageal transport function. The technique used to record axial force has developed from external force transducers over in-vivo strain gauges of various sizes to electrical impedance based measurements. The amplitude and duration of the axial force has been shown to be as reliable as manometry. Normal, as well as abnormal, manometric recordings occur with normal bolus transit, which have been documented using imaging modalities such as radiography and scintigraphy. This inconsistency using manometry has also been documented by axial force recordings. This underlines the lack of information when diagnostics are based on manometry alone. Increasing the volume of a bag mounted on a probe with combined axial force and manometry recordings showed that axial force amplitude increased by 130% in contrast to an increase of 30% using manometry. Using axial force in combination with manometry provides a more complete picture of esophageal motility, and the current paper outlines the advantages of using this method.

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Section: Resultsmentioning

confidence: 99%

Axial force measurement for esophageal function testing

Gravesen¹,

Funch‐Jensen²,

Gregersen³

et al. 2009

WJG

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“…Cerrahi tamir hedefleri semptomları geçir-mek, cerrahi işlemle ilgili morbidite ve mortaliteyi düşürmek, bakım maliyetini azaltmak ve tekrarlama olasılığını azaltmaktır. Ancak uygulanacak cerrahi tedavinin şekli konusunda tartışmalar olmaktadır (13)(14)(15)(16). Torakotomiyi daha morbit bulup batından yaklaşımı tercih edenler olduğu gibi, periözofajit gibi ortaya çıkabilecek iltihabi sorunlardan ötürü yoğun plevral yapışıklıklara hakim olabilmek için torakstan yaklaşımı uygun bulanlar da vardır.…”

Section: Cerrahi Tekniklerunclassified

“…Bu işlemde başarı oranı %85-95 civarlarındadır (13)(14)(15). Antireflü işlemlerin güvenilirliği ve komplikasyon oranları değişkenlik göstermektedir (15,16). Belsey Mark IV'ün başarı oranı %85'lerdedir (10,16).…”

Section: Cerrahi Tekniklerunclassified

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Paraesophageal Hiatal Hernias

Sayır¹

2011

Toraks Cer Bult

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ÖzetDiyafragma, solunumun en önemli kasıdır. Hiatus hernisi, diyafragmanın özofagial hiatustaki anatomik zayıflık ya da defekt nedeniyle intraabdominal organların toraksa çıkışı olarak tanımlanabilir. Hiatal herniler iki kategoriye ayrılır: sliding ve paraözofagial. Paraözofagial hernide gastroö-zofagial bileşke yerindedir fakat midenin bir kısmı ve veya diğer intestinal yapılar özofagusun yanından toraksa fıtıkla-şır. İnkarserasyon, strangülasyon bu tip hernide gelişebilir. Karın ağrısı, sindirim bozukluğu, kusma, ani şiddetli ağrı, yutma güçlüğü, bulantı gibi semptomlar görülebilir. Tanıda gastrointestinal sistem tanı metotları, endoskopi, manometri ve diğer tanı metotlarından faydalanılır. Eğer hiatal herni semptomatikse veya strangülasyon ve inkarserasyon söz konusuysa herni, torakotomi, laparatomi ya da laparoskopi girişimlerinden biri kullanılarak redükte edilmelidir. Anahtar kelimeler: Paraözofagial herni, cerrahi AbstractThe diaphragm is the most important respiratory muscle. Hiatus hernia can be defined as upward displacement of intraabdominal organs into the thorax due to an anatomic weakness or a defect with esophageal hiatus. There are two categories of hiatal hernias, sliding and paraesophageal. In paraesophageal hernias, the gastro-esophageal junction remains in place, but some part of the stomach and/or other intestinal organs are herniated into the chest. Incarceration and strangulation may occur in this type of hernia. Stomach pain, indigestion, difficulty in swallowing, nausea, vomiting and sudden severe chest pain are the symptoms. Upper gastrointestinal investigation such as endoscopy, manometry and other diagnostic procedures are helpful for the diagnosis. If the hiatus hernia is symptomatic or there is strangulation or incarceration, the hernia should be reduced by surgery via laparotomy, thoracotomy or laparoscopic approaches.

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“…[23][24][25][26] Multiple adult studies have shown that patients who have abnormal pHmetry and pHMII findings preoperatively are most likely to benefit most from fundoplication. [27][28][29] This experience have not easily translated to the pediatric setting, where pH-metry and pHMII based symptom association is harder to apply. In children, Rosen et al used pHMII to predict fundoplication outcome.…”

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confidence: 99%

New Insights in Gastroesophageal Reflux, Esophageal Function and Gastric Emptying in Relation to Dysphagia Before and After Anti-Reflux Surgery in Children

Smits

Loots

Benninga

et al. 2013

Curr Gastroenterol Rep

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Introduction Gastroesophageal reflux disease and treatment in childrenGastroesophageal reflux disease (GERD) in children is common, it affects approximately (?)3% of infants and <1% of older children. 1 GERD is clinically diagnosed when gastroesophageal reflux (GER) causes troublesome symptoms, and is a source of stress for both patients and caregivers. In infants, GERD is often mild and short lived, with >90% being free of GERD symptoms at the age of 18 months. 2,3 'Symptomatic GERD', that is a clinical diagnosis of GERD without corroborative evidence such as endoscopic evidence of esophagitis, can be challenging to treat. Standard treatment consists firstly of conservative measures: lifestyle changes, excess weight reduction, no exposure to tobacco smoke. In specific cases allergies are associated with GERD, and avoidance of allergens may relieve symptoms.If pharmacological therapy is considered, acid suppression is the first choice and using proton pump inhibitors (PPIs) is favored above H2-antagonists and on demand buffering agents. 2 However, acid suppression therapy in infants and children is now widely discouraged as PPIs, whilst proven effective in increasing gastric pH, do not reduce GERD symptoms. 4 The lack of therapeutic efficacy of acid suppressive therapy might be explained by the fact that acid suppression does not target the underlying mechanism of reflux which is transient lower sphincter relaxation (TLESR). 3,5 Acid suppression only turns acid GER into weakly acid GER, which may still cause troublesome symptoms. Although other therapeutic agents are being developed for adult GERD treatment (especially GABA(B) agonists and mGLUR5 antagonists), these have many sideeffects and are not yet tested in children. 6,7 Therefore, no pharmacological interventions aimed a reducing TLESRs are available.In patients with objective evidence of acid-related GERD, based on upper endoscopy, pH-metry and/or pH impedance measurement (pHMII), who experience severe symptoms or have esophagitis refractory to optimal medical therapy, anti-reflux surgery (fundoplication) may be a treatment of last resort. 8Indications for fundoplication are poorly defined in children 2,9,10 and there is no uniformity between hospitals in the approach to infants and children with pharmacological therapy resistant GERD. 11 Neurologically impaired children, children with a history of esophageal atresia 12 and children with respiratory alarm symptoms considered GERD-related (e.g. apnea, bronchiectasis, recurrent pneumonia) are more prone to undergo fundoplication. Fundoplication techniquesThe primary goal of anti-reflux surgery is to reduce GER without preventing passage into the stomach of swallowed substances. These conclusions are however based on limited data and uncertainty remains with respect to the optimal fundoplication technique. In addition prospective evidence is limited in terms of efficacy and complication rates between partial and total fundoplication. 19 Efficacy and safety of fundoplicationEfficacy and safety o...

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Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility

Cited by 188 publications

References 46 publications

Axial force measurement for esophageal function testing

Axial force measurement for esophageal function testing

Paraesophageal Hiatal Hernias

New Insights in Gastroesophageal Reflux, Esophageal Function and Gastric Emptying in Relation to Dysphagia Before and After Anti-Reflux Surgery in Children

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