Long-Term Results (6–10 Years) of Laparoscopic Fundoplication

Abstract

Most papers report excellent results of laparoscopic fundoplication but with relatively short follow-up. Only few studies have a follow-up longer than 5 years. We prospectively collected data of 399 consecutive patients with gastroesophageal reflux disease (GERD) or large paraesophageal/mixed hiatal hernia who underwent laparoscopic fundoplication between January 1992 and June 2005. Preoperative workup included symptoms questionnaire, videoesophagogram, upper endoscopy, manometry, and pH-metry. Postoperative clinical/functional studies were performed at 1, 6, 12 months, and thereafter every other year. Patients were divided into four groups: GERD with nonerosive esophagitis, erosive esophagitis, Barrett's esophagus, and large paraesophageal/mixed hiatal hernia. Surgical failures were considered as follows: (1) recurrence of GERD symptoms or abnormal 24-h pH monitoring; (2) recurrence of endoscopic esophagitis; (3) recurrence of hiatal hernia/slipped fundoplication on endoscopy/barium swallow; (4) postoperative onset of dysphagia; (5) postoperative onset of gas bloating. One hundred and forty-five patients (87 M:58 F) were operated between January 1992 and June 1999: 80 nonerosive esophagitis, 29 erosive esophagitis, 17 Barrett's esophagus, and 19 large paraesophageal/mixed hiatal hernias. At a median follow-up of 97 months, the success rate was 74% for surgery only and 86% for primary surgery and 'complementary' treatments (21 patients: 13 redo surgery and eight endoscopic dilations). Dysphagia and recurrence of reflux were the most frequent causes of failure for nonerosive esophagitis patients; recurrence of hernia was prevalent among patients with large paraesophageal/mixed hiatal hernia. Gas bloating (causing failure) was reported by nonerosive esophagitis patients only. At last follow-up, 115 patients were off 'proton-pump inhibitors'; 30 were still on medications (eight for causes unrelated to GERD). Conclusion confirms that laparoscopic fundoplication provides effective, long-term treatment of gastroesophageal reflux disease. Hernia recurrence and dysphagia are its weak points.

Hiatal Hernia, Lower Esophageal Sphincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of Gastroesophageal Reflux Disease

“…8 Numerous studies have shown that patients with ERD or BE are effectively treated by antireflux surgery, with safe, long-term control of reflux symptoms, normalization of esophageal acid and nonacid exposure, and a significant improvement in quality of life. [10][11][12][13][14] Few data, in contrast, are available on the results of surgical therapy for all stages of the GERD spectrum including NERD. 13,15 The results of surgical treatment are especially important for patients with NERD as medical treatments are widely reported as being less effective for these patients.…”

“…[10][11][12][13][14] Few data, in contrast, are available on the results of surgical therapy for all stages of the GERD spectrum including NERD. 13,15 The results of surgical treatment are especially important for patients with NERD as medical treatments are widely reported as being less effective for these patients. [16][17][18] In this study, we investigated the influence of the endoscopically defined GERD stage on the outcome of laparoscopic Nissen fundoplication.…”

Postfundoplication Dysphagia Causes Similar Water Ingestion Dynamics as Achalasia

“…Laparoscopic fundoplication is a good option to treat gastroesophageal reflux disease, with the improvement of symptoms in 80%-90% of patients (15,31,32) . In almost all patients, dysphagia is a post-treatment complication that lasts for about 6 weeks and then disappears, while in some, the complication persist beyond 6 weeks (4,31) .…”

Dilatation rupture of the stomach in the setting of acute mechanical intestinal obstruction in a patient after surgical treatment of hiatal hernia (on the issue of surgical management of gastroesophageal reflux disease)

“…Связано это с несколькими факторами. При проведении операций по поводу ГЭРБ, особенно выполненных по традиционной методике, все еще встречается довольно большое число интра-и по-слеоперационных осложнений, которые, по неко-торым данным, встречаются в 24% случаев [23][24][25][26][27][28][29][30][31]. Так, вероятность возникновения перфорации пи-щевода и желудка достигает 9,1% [26,32], пневмо-торакс встречается в 4-5% наблюдений, даже при проведении робото-ассистированной операции [33,34].…”

“…Причем длительный прием этих препаратов необходим 5,8-62% опери-рованных пациентов [28,31,41,42,44,45,55,56]. Большинство исследований указывают на необхо-димость приема препаратов, снижающих кислот-ность у 20% оперированных пациентов, однако в одном рандоминизированном контролируемом ис-следовании авторы сообщили о возникновении не-обходимости приема этих препаратов у 62% опери-рованных пациентов [56].…”