Mechanisms and avoidance of esophageal perforation by anesthesia personnel during laparoscopic foregut surgery

Lowham, Anthony; Filipi, Charles J.; Hinder, Ronald A.; Swanström, Lee L.; Stalter, Kenneth D.; DePaula, Aureo L.; Hunter, John G.; Buglewicz, T. G.; Haake, K

doi:10.1007/s004649900218

Cited by 56 publications

(40 citation statements)

References 8 publications

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“…The use of wide calibration esophageal bougies, the other modification suggested by DeMeester et al, has been widely accepted [10,11]. However, the use of these bougies 2 cm in diameter can cause esophageal and gastric perforation at a rate close to 1 % [12,13]. A study querying the need for these bougies to decrease persistent dysphagia by Mathavan et al has studied fundoplication without bougies in 123 cases.…”

Section: Discussionmentioning

confidence: 99%

“…However, these bougies that have been originally prepared for esophagus dilatation are rigid and their tips are relatively sharp. These bougies require care and experience for their application and can cause prolonged surgery duration, esophageal and gastric mucosa damage, and even perforation [12][13][14]. Some studies also report that the calibration performed with these bougies with a diameter up to 60 F (2 cm) does not decrease the postoperative dysphagia rate [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Esophageal Calibration with Soft Orogasrtric Tube During Laparoscopic Nissen Fundoplication may Reduce Postoperative Transient Dysphagia

Bülbüller

Öner

2013

Indian J Surg

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Gastroesophageal reflux is the most common benign disorder of the esophagus and laparoscopic Nissen fundoplication has become the standard surgical treatment for its treatment. In our area, where the use of bougie calibration is debatable, postoperative dysphagia is encountered often after this surgery although it is usually not permanent. The aim of this study was to investigate the effect of using a soft silicone tube 39 F in diameter for esophageal calibration during laparoscopic Nissen fundoplication on the incidence of postoperative dysphagia. We divided cases scheduled to undergo laparoscopic Nissen fundoplication between January 2009 and November 2010 into two groups, each consisting 25 patients. Esophageal calibration with a 39 F silicone orogastric tube was used for the first group while there was no operative calibration in the second group. The surgical duration was recorded; the presence and severity of the postoperative dysphagia was calculated by using a dysphagia severity scoring system during the 1-year postoperative follow-up. The dysphagia severity scores were significantly lower in group 1 than group 2 on the postoperative second day and at the end of the first week and first month. We did not find a significant difference at the end of the 6-month and first year. There was also no significant difference regarding surgery duration. The use of a soft orogastric tube 39 F in diameter for esophagus calibration during laparoscopic Nissen fundoplication has significantly decreased the incidence of postoperative transient dysphagia without affecting the duration of surgery. Although dysphagia gradually resolves in the majority of patients, a safe and easy calibration method for its prevention is worth developing, and we believe that the use of our method in larger series could be beneficial.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esophageal Calibration with Soft Orogasrtric Tube During Laparoscopic Nissen Fundoplication may Reduce Postoperative Transient Dysphagia

Bülbüller

Öner

2013

Indian J Surg

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“…However, its routine use carries the risk of iatrogenic perforation, varying around 1% of cases. 111,112 Some authors, therefore, do not recommend its routine use. 113 Looking at the only available RCT, 72 it appears that routine use of a bougie significantly reduces the rate of severe postoperative dysphagia, as defined by the authors, by 13.7%, with a 1.2% risk of iatrogenic perforation (Table 10).…”

Section: Hiatoplasty and Calibrationmentioning

confidence: 99%

Evidence-Based Appraisal of Antireflux Fundoplication

Catarci

Gentileschi²,

Papi³

et al. 2004

Annals of Surgery

275

177

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Objective: To highlight the current available evidence in antireflux surgery through a systematic review of randomized controlled trials (RCTs). Summary Background Data: Laparoscopic fundoplication is currently suggested as the gold standard for the surgical treatment of gastroesophageal reflux disease, but many controversies are still open concerning the influence of some technical details on its results. Methods: Papers related to RCTs identified via a systematic literature search were evaluated according to standard criteria. Data regarding the patient sample, study methods, and outcomes were abstracted and summarized across studies. Defined outcomes were examined for 41 papers published from 1974 to 2002 related to 25 RCTs. A meta-analysis was performed pooling the results as odds ratios (OR), rate differences (RD), and number needed to treat (NNT). Data given as mean and/or median values were pooled as a mean Ϯ SD (SD). Results: No perioperative deaths were found in any of the RCTs. Immediate results showed a significantly lower operative morbidity rate (10.3% versus 26.7%, OR 0.33, RD Ϫ12%, NNT 8), shorter postoperative stay (3.1 versus 5.2 days, P ϭ 0.03), and shorter sick leave (20.1 versus 35.8 days, P ϭ 0.03) for laparoscopic versus open fundoplication. No significant differences were found regarding the incidence of recurrence, dysphagia, bloating, and reoperation for failure at midterm follow-up. No significant differences in operative morbidity (13.1% versus 9.4%) and in operative time (90.2 versus 84.2 minutes) were found in partial versus total fundoplication. A significantly lower incidence of reoperation for failure (1.6% versus 9.6%, OR 0.21, RD Ϫ7%, NNT 14) was found after partial fundoplication, with no significant differences regarding the incidence of recurrence and/or dysphagia. Routine division of short gastric vessels during total fundoplication showed no significant advantages regarding the incidence of postoperative dysphagia and recurrence when compared with no division. The use of ultrasonic scalpel compared with clips or bipolar cautery for the division of short gastric vessels showed no significant effect on operative time, postoperative complications, and costs. Conclusions: Laparoscopic antireflux surgery is at least as safe and as effective as its open counterpart, with reduced morbidity, shortened postoperative stay, and sick leave. Partial fundoplication significantly reduces the risk of reoperations for failure over total fundoplication. Routine versus no division of short gastric vessels showed no significant advantages. A word of caution is needed when implementing these results derived from RCTs performed in specialized centers into everyday clinical practice, where experience and skills may be suboptimal.

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“…20 A bougie is considered helpful in preventing postoperative dysphagia, but the use of a bougie results in a higher incidence of esophageal perforations. 21 A bougie was used in 19 of our patients, with 1 perforation. Because of this, we have now abandoned the use of bougies.…”

Section: Commentmentioning

confidence: 99%