Laparoscopic Surgery for Gastroesophageal Reflux Disease Patients with Impaired Esophageal Peristalsis: Total or Partial Fundoplication?

Chrysos, Emmanuel; Tsiaoussis, John; Zoras, Odysseas; Athanasakis, Elias; Mantides, Apostolos; Katsamouris, Asterios; Xynos, Evaghelos

doi:10.1016/s1072-7515(03)00151-0

Cited by 114 publications

(96 citation statements)

References 36 publications

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“…Maybe these differences are due to different diagnostic criteria or limited sample size. The fact that the dysphagia rate did not increase in our study population supports the views of other authors, that there is no difference in the incidences of dysphagia after Nissen or partial fundoplication [24,25,30]. …”

Section: Discussionsupporting

confidence: 90%

“…Biertho et al [23] reported similar results to ours regarding esophageal motility: as shown in our study, motility after Nissen fundoplication did not change in the NORM group, but improved to a statistically significant degree in the dysmotility group. In fact, Chrysos et al [24] reported from their prospective randomized trial that lower postoperative dysphagia rates in dysmotility patients after partial fundoplication compared to Nissen patients disappear after 12 months of follow-up. A recent large, randomized study in Germany comparing Nissen and Toupet fundoplication in patients with and without motility disorder reported no need for tailored surgical approaches relating to preoperative esophageal motility [14].…”

Section: Discussionmentioning

confidence: 99%

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Effect of Laparoscopic Antireflux Surgery on Esophageal Motility

Fuchs

Gutschow²,

Brinkmann³

et al. 2014

Dig Surg

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Background/Aims: The effect of laparoscopic antireflux surgery on esophageal motility is incompletely understood, and any indication for this procedure in patients with motility disorder is disputed in literature. We evaluated the influence of laparoscopic Nissen fundoplication on impaired esophageal motility. Methods: In this pathological manometric study, we divided the patients into two groups preoperatively: the hypomotility group (mean amplitude of esophageal contraction wave <40 mm Hg; HYPO group, n = 11) and the normal group (mean amplitude of esophageal contraction wave >40 mm Hg; NORM group, n = 43). The amplitudes of esophageal contraction waves 3 and 8 cm above the lower esophageal sphincter and the percentage of peristaltic contraction waves of the tubular esophagus were analyzed pre- and postoperatively. Results: In total, 54 patients with GERD underwent esophageal manometry before and 6 months after Nissen fundoplication. The length and pressure of the lower esophageal sphincter were increased in both groups postoperatively (p < 0.01). Patients in the HYPO group (n = 11) showed a statistically significant increase of mean amplitude of esophageal contraction (32.8 vs. 57.3 mm Hg; p < 0.01), while no change was found in the NORM group (n = 43). A total of 72% of patients with preoperative motility disorder showed normal postoperative manometry. Conclusion: Nissen fundoplication normalizes esophageal motility, especially in patients with preoperative hypomotility. Patients with impaired esophageal motility should not per se be excluded from antireflux surgery.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Effect of Laparoscopic Antireflux Surgery on Esophageal Motility

Fuchs

Gutschow²,

Brinkmann³

et al. 2014

Dig Surg

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“…RCTs have shown that outcome of fundoplication is similar in patients with normal and abnormal esophageal motility [37][38][39][40] . Study population and surgical interventions were similar between trials in all other aspects.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Anterior 180-Degree Versus Nissen Fundoplication for Gastroesophageal Reflux Disease

et al. 2013

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Running headAnterior 180˚ versus Nissen fundoplication for GERD: a meta-analysis Word count 3161Archived at the Flinders Academic Commons: http://dspace.flinders.edu.au/dspace/ 2 Mini-AbstractSystematic review and meta-analysis demonstrating that laparoscopic anterior 180˚ fundoplication (180˚ LAF) reduces short and longer-term dysphagia and gas-related symptoms compared to laparoscopic Nissen fundoplication, with similar reflux control, dilatations and reoperation rate. These results lend level 1a support for the use of 180˚ LAF for the surgical treatment of GERD.Archived at the Flinders Academic Commons: http://dspace.flinders.edu.au/dspace/ 3 Structured abstractObjective: To compare short and longer-term outcome after laparoscopic anterior 180˚ fundoplication (180˚ LAF) versus laparoscopic Nissen fundoplication (LNF). Summary of background data:LNF is currently the most frequently performed surgical therapy for GORD. Alternatively, 180˚ LAF has been alleged to reduce troublesome dysphagia and gas-related symptoms, with similar reflux control. Methods Conclusions:At one and five years, dysphagia and gas-related symptoms are lower after 180˚ LAF compared with LNF, and esophageal acid exposure and esophagitis are similar, with no differences in heartburn scores, patient satisfaction, dilatations and reoperation rate.These results lend level 1a support for the use of 180˚ LAF for the surgical treatment of GERD.

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Section: Editorialmentioning

confidence: 99%

“…Computed Tomography (CT) imaging provides enhanced view of the involved structures, especially in large paraoesophageal hernia cases. pH and manometry studies can provide further information regarding gastrooesophageal reflux and oesophageal dysmotility, which in turn can influence the tailoring of surgical approach and technique of fundoplication should this be advocated [4].The majority of published studies suggest that paraoesophageal hernias in low-risk surgical patients should be repaired to prevent the development of potentially life-threatening complications [5]. This has been especially encouraged with the advancement of laparoscopy and the widely available high definition systems including the new 3D optical systems that have emerged mainly during the last quinquennium.…”

mentioning

confidence: 99%

Paraoesophageal Hernias: A Surgical Perspective

Farhangmehr¹,

Liakakos²,

Àlex³

et al. 2017

J Gastrointest Dig Syst

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EditorialHiatal hernias refer to the condition where intra-abdominal structures herniate into the mediastinum through the oesophageal hiatus. They occur in about 10% of the population. Hiatal hernias are classified in 4 types. Type I or sliding hernia represents 85%-90% of all hiatal hernias. It results from laxity and loss of coherence of the phreno-oesophageal membrane. The gastro-oesophageal junction (GOJ) is displaced above the diaphragm while the fundus remains below the GOJ. Hiatal hernias type II, III and IV or collectively known as paraesophageal hernias represent about 10%-15% of hiatal hernias. Type II hernia results from a localized defect in the phrenooesophageal membrane. The gastric fundus herniates into the mediastinum, while the GOJ remains fixed to the preaortic fascia and the median arcuate ligament. Type III paraoesophageal hernias have elements of both types I and II and have both the GOJ and the fundus herniating through the hiatus. Type IV hiatus hernia is associated with a large defect in the diaphragm defined by the presence of organs other than the stomach in the hernia sac commonly being the transverse colon, spleen, pancreas or small bowel.Paraoesophageal hernia is a condition mainly seen in the elderly population. In most large series, presentation with a median age of 65 to 75 years appears to be the rule [1]. Risk factors for developing hiatal hernia include age greater than 50, BMI>25 and male gender [2]. About 50% of cases are asymptomatic and the hernia is an incidental finding on imaging or endoscopy. In sliding hernias reflux symptoms such as heartburn and regurgitation are more frequent; whilst in paraoesophagheal hernias common symptoms include epigastric or substernal pain, postprandial fullness, dysphagia, nausea, vomiting and dyspnoea. Microcytic anaemia can be present secondary to erosions of the gastric mucosa. Acute symptoms due to gastric outlet obstruction/ gastric volvulus, uncontrolled bleeding, strangulation, perforation, and respiratory compromise are indications for urgent surgery.Hiatus hernia can be an incidental finding on a chest X-ray where the gastric bubble can be seen in the chest. On barium swallow the presence of more than 2 cm separation between the B ring (level of squamocolumnar junction) and the diaphragm suggests a sliding hiatus hernia. If a B ring is not evident on barium swallow (absent in 85% of individuals), the demonstration of at least three rugal folds traversing the diaphragm is diagnostic of a sliding hiatus hernia [3]. In paraoesophageal hernias there is evidence of the fundus herniating into the mediastinum. On endoscopy a sliding hernia is defined as a greater than 2 cm distance between the squamocolumnar junction and the diaphragmatic impression on the stomach [3]. In paraoesophageal hernias the hernia can be visualised on retroflexion (J manoeuvre) of the endoscope that reveals a portion of the stomach, herniating upward through the diaphragm, adjacent to the endoscope [3]. Another indirect indicator of paraoesophageal hernia that sh...

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Laparoscopic Surgery for Gastroesophageal Reflux Disease Patients with Impaired Esophageal Peristalsis: Total or Partial Fundoplication?

Cited by 114 publications

References 36 publications

Effect of Laparoscopic Antireflux Surgery on Esophageal Motility

Effect of Laparoscopic Antireflux Surgery on Esophageal Motility

Laparoscopic Anterior 180-Degree Versus Nissen Fundoplication for Gastroesophageal Reflux Disease

Paraoesophageal Hernias: A Surgical Perspective

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