Long-term results of antireflux surgery indicate the need for a randomized clinical trial

Sandbu, Rune; Khamis, Harry J.; Gustavsson, Sven; Haglund, Ulf

doi:10.1046/j.0007-1323.2001.01990.x

Cited by 18 publications

(28 citation statements)

References 32 publications

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“…Recent retrospective analyses comparing open and laparoscopic antireflux procedures suggested that the open technique results in better symptomatic control than the laparoscopic [3,33], with recurrence rates of 29% after laparoscopy. These authors advocated prospective trials comparing open and laparoscopic approach.…”

Section: Discussionmentioning

confidence: 98%

“…Recently, the surgical treatment for GERD, and in particular the use of the laparoscopic technique for GERD, have been questioned,. The criticism is either based on retrospective reports of high rates of symptomatic recurrence [3], increased rates of postoperative dysphagia after Nissen procedures [4], or high rates of postoperative use of antireflux medication [5].…”

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confidence: 99%

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Open vs laparoscopic partial posterior fundoplication

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

Open vs laparoscopic partial posterior fundoplication

et al. 2007

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“…36 The majority of authors agree that the main reasons for failures are technical errors in the performance of surgery such as asymmetric wrap, early disruption, wrap migration, and slipped fundoplication producing abnormal deformities, clearly demonstrated by radiologic and endoscopic assessment. [37][38][39][40][41][42] The recurrence rate of erosive esophagitis resulting from failure of antireflux operation ranges from 3% to 16%, most of them caused by a misperformed surgical procedure with a high proportion of positive acid reflux tests after the operation. 23 Mickevicius et al 43 suggests that a wrap length is important in fundoplication in order to avoid postsurgical failures.…”

Section: Discussionmentioning

confidence: 99%

“…[37][38][39][40][41][42] The recurrence rate of erosive esophagitis resulting from failure of antireflux operation ranges from 3% to 16%, most of them caused by a misperformed surgical procedure with a high proportion of positive acid reflux tests after the operation.…”

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confidence: 99%

Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

Braghetto

Korn

Csendes

et al. 2012

International Surgery

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After antireflux surgery for gastroesophageal reflux disease, 10% to 15% of patients may have unsuccessful results as a result of abnormal restoration of the esophagogastric junction. The purpose of this study was to evaluate the postoperative endoscopic and radiologic characteristics of the antireflux barrier and their correlation with the postoperative results. After surgery, endoscopic and radiologic features of the antireflux wrap were evaluated in 120 consecutive patients. Jobe's classification of the postoperative valve was used for the definition of a ''normal'' or ''defective'' wrap. Patients were evaluated 3 to 5 years later in order to determine the clinical and objective failed fundoplication. A ''normal'' antireflux wrap was associated with successful results in 81.7% of the patients. On the contrary, defective radiologic or endoscopic antireflux wrap was observed in 19% of cases. Among these patients, hypotensive lower esophageal sphincter was observed in 50% to 65% of patients, abnormal 24-hour pH monitoring in 91%, and recurrent postoperative erosive esophagitis in 50% of patients, respectively (P , 0.001). ''Defective'' antireflux fundoplication is associated with recurrent reflux symptoms, presence of endoscopic esophagitis, hypotensive lower esophageal sphincter, and abnormal acid reflux.Key words: Antireflux surgery -Postoperative failures -Defective fundoplication P atients with gastroesophageal reflux disease (GERD) have anatomic defects of the esophagogastric junction (EGJ) as dilatation of the cardia and/or presence of hiatal hernia. [1][2][3][4] These defects have been associated with incompetence of the lower esophageal sphincter (LES) and pathologic acid reflux. The aim of antireflux surgery is to create an antireflux barrier by increasing the competence of the LES and to avoid this abnormal acid reflux. However, failure of antireflux surgery has been reported in several publications and pathologic acid reflux test can be observed in 5% to 15% of GERD patients. 5,6 Zaninotto et al 6 reported 13.2% of reflux recurrence in patients with GERD (6.2% in patients with grade 0 to I esophagitis and 7% in patients with grade-II esophagitis, respectively). Presence of abnormal acid reflux has been reported after Nissen fundoplication as well as after Toupet or cardial calibration in a very similar percentage of cases. 7-9The restoration of the cardial anatomic integrity is followed by a successful outcome after surgery. On the contrary, some authors have published endoscopic or radiologic failures after fundoplication, with defective antireflux wrap associated with a high rate of symptomatic and objective reflux recurrence reaching up to 25% of cases. 2,10The purpose of this prospective study was to correlate the presence of postoperative radiologic and endoscopic defects of the new antireflux barrier after surgery and its association with persistence of symptoms, endoscopic esophagitis, hypotensive LES, and abnormal 24-hour pH monitoring. Patients and Methods Patients studiedIn this prospective ...

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“…After a posterior partial fundoplication, however, gas insufflation into the stomach seldom elicits TLESRs, but it is slightly more commonly after a total fundoplication. More importantly when a TLESR occurs after a partial wrap, it is associated with a lower nadir pressure in the LES; a larger number of common cavities suggestive of a better restored ability to vent air from the stomach compared to those having a total fundoplication [98,[110][111][112][113][114][115]. …”

Section: Lower Esophageal Sphincter Functionmentioning

confidence: 99%

Surgery of Gastroesophageal Reflux Disease: A Competitive or Complementary Procedure?

Lundell

2004

Dig Dis

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The management of chronic gastroesophageal reflux disease (GERD) has both been simplified and immensely improved by the development of modern medical therapies. These are built entirely on the concept of profound acid inhibition, which is very successful in a substantial proportion of GERD patients. Despite the efficacy of proton pump inhibitors (PPIs) some failures are unavoidable, and some patients experience incomplete control of major GERD symptoms on ordinary dosing of PPIs. Although the safety profile of PPIs is very reassuring, some people express some concern about the safety of drug treatment extending beyond 10 years especially when alternative therapeutic strategies are available. Some patients complain of alleged respiratory complications to severe reflux, and in those situations as well as in cases with e.g. Barrett’s esophagus, a complete control of reflux also incorporating the duodenal components in the refluxate may be warranted. In all those situations antireflux surgery can be considered indicated for the treatment of chronic GERD and thus be looked upon as complementary to medical therapy. Furthermore, some patients who have their GERD symptoms under control on PPIs still want to have an operation to avoid dependency on drugs. Hence in none of these clinical situations does antireflux surgery play a competitive role in relation to medical therapy. However, in the very few randomized clinical trials in which a head-to-head comparison has been completed between medical and surgical therapy, the latter has been found to be somewhat more effective in terms of reflux control. The other side of the coin is that antireflux surgery has some side effects that signify the importance of this surgery being performed in specialized centers.

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Long-term results of antireflux surgery indicate the need for a randomized clinical trial

Abstract: This study does not support the presumption that laparoscopic antireflux surgery is to be preferred to the open procedure. It is strongly recommended that a randomized controlled trial be conducted.

Cited by 18 publications

References 32 publications

Open vs laparoscopic partial posterior fundoplication

Open vs laparoscopic partial posterior fundoplication

Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

Surgery of Gastroesophageal Reflux Disease: A Competitive or Complementary Procedure?

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