Long-term results of nissen fundoplication in reflux esophagitis without strictures

Haro, Luisa F. Martínez de; Ortiz, A. S.; P, Parrilla Paricio; Marcilla, José Antonio García; Aguayo, José Luis; Morales, G.

doi:10.1007/bf01307574

Cited by 44 publications

(13 citation statements)

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“…After a median follow-up of 5 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] in the BE group and 6 years (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] in the non-BE group, the rate of clinical recurrence was 8% in the BE group and 10% in the non-BE group, with no statistically significant difference. The rate of pH-metric recurrence was the same in both groups (15%).…”

Section: Resultsmentioning

confidence: 99%

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Barrett’s Esophagus Without Esophageal Stricture Does Not Increase the Rate of Failure of Nissen Fundoplication

et al. 2003

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Section: Resultsmentioning

confidence: 99%

“…Second, in our experience and in that of others, 2,4,10 -12,15,29 -35 standard antireflux surgery achieves excellent results in most cases. On the other hand, several functional studies have shown that standard antireflux surgery efficiently controls both acid 2,9,11 and biliopancreatic 36 reflux into the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Barrett’s Esophagus Without Esophageal Stricture Does Not Increase the Rate of Failure of Nissen Fundoplication

et al. 2003

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“…'3-16 Twenty four hour pH metry is especially helpful in diagnosing gastro-oesophageal reflux disease in patients with reflux symptoms in the absence of endoscopic oesophagitis.16 The technique is also applicable to evaluate the efficacy of medical or surgical treatment. Recent studies have shown that the Nissen fundoplication significantly decreases gastrooesophageal reflux with normalisation of 24 hour pH metry parameters in up to 80% of patients.7 [17][18][19][20] Little is known, however, on the effect of the Belsey Mark IV antireflux procedure on 24 hour pH metry variables. The aims of this study were therefore to evaluate the efficacy of the Belsey Mark IV fundoplication with special emphasis on 24 hour pH metry and the relation between lower oesophageal sphincter pressure and pH metry data.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery.

Horbach

Masclee

Lamers

et al. 1994

Gut

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This study evaluated the effect of the 2700 Belsey Mark IV fundoplication on 24 hour ambulatory pH metry variables. Thirty seven patients with confirmed gastrooesophageal reflux disease who had a Belsey Mark IV antireflux procedure were evaluated preoperatively and three to six months postoperatively including endoscopy, lower oesophageal sphincter manometry, and 24 hour ambulatory pH metry. In 30 of 37 patients the Belsey Mark IV fundoplication was judged successful based on symptom relief and healing of oesophagitis. In these 30 patients percentage reflux for total, upright, and supine time (median and range) decreased significantly (p<0.001) from 10-0% (2.7-35.3%)/ 10X8% (3-2-39-9%), and 6-7 (0.0-33-0%) respectively to 0.5% (0.0-7-4%), 0-6% (0.0-13.7%), and 0.1% (0O0-4/9%) after operation. This decrease in reflux time resulted predominantly from a significant (p<0001) reduction in the number of reflux episodes from 98 (23-231) to 14 (0-82) postoperatively. Normalisation of total reflux time (upper limit of normal for time with pH below 4:4%) was found in 89% and normalisation of total and upright and supine reflux in 64% of successfully operated patients with confirmed abnormal acid reflux before operation. A successful antireflux procedure was associated with significant (p<0.001) increases in lower oesophageal sphincter pressure from 7*8 (0.6) mm Hg to 14-5 (0-7) mm Hg mean (SEM). In seven patients with a failed antireflux operation basal lower oesophageal sphincter pressure did not change significantly (preoperative value 5-7 (1-3) mm Hg; postoperative value 7-8 (0.8) mm Hg). In these patients reflux time did not decrease after the operation and remained in the abnormal range in all patients. It is concluded that a successful, in contrast with a failed, Belsey Mark IV fundoplication is associated with significant decreases in total, upright, and supine reflux time. Normalisation of pH metry variables is not a prerequisite for successful antireflux surgery.

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“…After laparoscopic fundoplication, anatomic alterations of the EGJ are observed in 2% in non-Barrett's esophagus patients versus 16% in patients with Barrett's esophagus. [19][20][21][22][23][24][25][26][27][28] Martínez de Haro et al, 29 in 51 patients with reflux esophagitis followed for more than 6 years, obtained good results in 89% of patients, but endoscopic recurrence was higher (14%) and pathologic acid reflux confirmed by 24-hour pH monitoring was 20% after surgery. In Barrett's esophagus patients, the results are even worse.…”

Section: Discussionmentioning

confidence: 98%

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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Long-term results of nissen fundoplication in reflux esophagitis without strictures

Cited by 44 publications

References 14 publications

Barrett’s Esophagus Without Esophageal Stricture Does Not Increase the Rate of Failure of Nissen Fundoplication

Barrett’s Esophagus Without Esophageal Stricture Does Not Increase the Rate of Failure of Nissen Fundoplication

Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery.

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

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