Long-term outcome of laparoscopic Nissen fundoplication in a regional hospital setting

Prassas, Dimitrios; Krieg, Andreas; Rolfs, Thomas-Marten; Schumacher, Franz-Josef

doi:10.1016/j.ijsu.2017.08.580

Cited by 10 publications

(26 citation statements)

References 18 publications

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“…The most prevalent symptoms observed were heartburn, regurgitation, and dysphagia, coinciding with foregoing data [51]. When observing long-term heartburn relief, previous studies have reported that up to 93.8% of patients have none or only mild heartburn after LNF [5, 20]. In our study, a full elimination of heartburn was achieved in 83% of the patients, with 95% of the patients expressing satisfaction with its management.…”

Section: Discussionsupporting

confidence: 88%

“…In our study, a full elimination of heartburn was achieved in 83% of the patients, with 95% of the patients expressing satisfaction with its management. Although postoperative PPI use has been relatively common, ranging from 5.8 to 62%, 13% of our patients reported still daily use of PPIs, while additional 4% required only occasional PPI intake [2, 3, 5, 20]. …”

Section: Discussionmentioning

confidence: 99%

“…When compared with current literature, a sample size of that quantity is a rare finding, as GERD patients undergone laparoscopic anti-reflux surgery frequently have a good outcome and therefore have no need for further follow-up. Up to date, other than meta-analyses, no study has been published with a long-term LNF follow-up of up to 16 years with a sample size greater than ours [5, 53–58]. …”

Section: Discussionmentioning

confidence: 99%

“…The only definite treatment of GERD and prevention of its severe long-term consequences is surgical enhancement and reconstruction of the weakened LES, inhibiting reflux of gastric contents in to the esophagus. So far, the LNF has been the standard anti-reflux surgery with proven long-term efficacy and safety as well as verified improvement in quality of life in patients undergone LNF [4, 5, 8, 9, 20]. Nevertheless, it is associated with several complications like PD and gas-bloat syndrome, potentially leading to further surgical interventions and patient dissatisfaction [3, 7–11, 20].…”

Section: Discussionmentioning

confidence: 99%

“…Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal disorders, reaching a prevalence up to 30% in the Western World [1–8]. Although the gold standard in treatment remains surgical repair by laparoscopic fundoplication, patients opt to undergo surgery only when first-line treatment with proton pump inhibitors (PPIs) fails and quality of life is reduced or a risk of developing adenocarcinoma develops [4, 5, 8, 9]. One of the reasons behind a low surgery rate among GERD patients is the fear of its adverse effects [3, 4, 9].…”

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confidence: 99%

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Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

et al. 2018

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

et al. 2018

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Additional fundophrenicopexia, after Nissen fundoplication, reduces postoperative dysphagia and re-operation rate in the long-term follow up

et al. 2021

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Background Various technical modifications of Nissen fundoplication (NF) that aim to improve patients’ outcomes have been discussed. This study aims to evaluate the effect of division of the short gastric vessels (SGV) and the addition of a standardized fundophrenicopexia on the postoperative outcome after NF. Methods 283 consecutive patients with GERD treated with NF were divided into four groups following consecutive time periods: with division of the SGV and without fundophrenicopexia (group A), with division of the SGV and with fundophrenicopexia (group B), without division of the SGV and with fundophrenicopexia (group C) and without division of the SGV and without fundophrenicopexia (group D). Postoperative contrast swallow, dysphagia scoring, GEDR-HRQL and proton pump inhibitor intake were evaluated. A comparative analysis of patients with division of the SGV and those without (161 A + B vs. 122 C + D), and patients with fundophrenicopexia and those without (78 A vs. 83 B and 49 C vs. 73 D) was performed. Results Fundophrenicopexia reduced postoperative dysphagia rates (0 group C vs. 5 group D, p = 0.021) in patients where the SGV were preserved and reoperation rates (1 group B vs. 7 group A, p = 0.017) in patients where the SGV were divided. There was no significant difference in the postoperative rates of heartburn relief, dysphagia, gas bloating syndrome, interventions, re-fundoplication and the GERD-HRQL score between groups A + B and C + D, respectively. Conclusion Standardized additional fundophrenicopexia in patients undergoing Nissen fundoplication significantly reduces postoperative dysphagia in patients without division of the SGV and reoperation rates in patients with division of the SGV. Division of the SGV has no influence on the postoperative outcome of NF.

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Postoperative Dysphagia Following Esophagogastric Fundoplication: Does the Timing to First Dilation Matter?

Athanasiadis

Selzer

Stefanidis

et al. 2021

Journal of Gastrointestinal Surgery

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Background: Postoperative dysphagia after anti-reflux surgery typically resolves in a few weeks. However, even after the initial swelling has resolved at 6 weeks, dysphagia can persist in 30% of patients necessitating esophageal dilation. The purpose of this study was to investigate the effect of esophageal dilation on postoperative dysphagia, the recurrence of reflux symptoms, and the efficacy of pneumatic dilations on post-operative dysphagia.Methods: A prospectively collected database was reviewed for patients who underwent partial/complete fundoplication with/without paraesophageal hernia repair between 2006-2014.Patient age, sex, BMI, DeMeester score, procedure type, procedure duration, length of stay, postoperative dysphagia, time to first pneumatic dilation, number of dilations, and the need for reoperations were collected. Results:The study included 902 consecutive patients, 71.3% females, with a mean age of 57.8±14.7 years. Postoperative dysphagia was noted in 26.3% of patients, of whom 89% had complete fundoplication (p<0.01). Endoscopic dilation was performed in 93 patients (10.3%) with 59 (63.4%) demonstrating persistent dysphagia. Recurrent reflux symptoms occurred in 35 (38%) patients who underwent endoscopic dilation.Patients who underwent a dilation had a smaller revision rate than patients who did not undergo a dilation before revision (17.2% vs 41.7%, respectively, p<0.001) in the four-year follow-up period. The duration of initial dilation from surgery was inversely related to the need for revisional surgery (p=0.047), while more than one dilation was not associated with additive benefit. Conclusion:One attempt at endoscopic dilation of the esophagogastric fundoplication may provide relief in patients with postoperative dysphagia and can be used as a predictive factor for the need of revision. However, there is an increased risk for recurrent reflux symptoms and revisional surgery may ultimately be indicated for control of symptoms.

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Long-term outcome of laparoscopic Nissen fundoplication in a regional hospital setting

Abstract: Laparoscopic Nissen fundoplication is a safe method with significant long-term efficacy in terms of symptom control and quality of life, even when; performed in a low-volume, community-hospital setting.

Cited by 10 publications

References 18 publications

Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

Persistent dysphagia is a rare problem after laparoscopic Nissen fundoplication

Additional fundophrenicopexia, after Nissen fundoplication, reduces postoperative dysphagia and re-operation rate in the long-term follow up

Postoperative Dysphagia Following Esophagogastric Fundoplication: Does the Timing to First Dilation Matter?

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