Post-fundoplication symptoms and complications: Diagnostic approach and treatment

Sobrino-Cossío, Sergio; Soto-Pérez, Julio César; Coss‐Adame, Enrique; Mateos-Pérez, G.; Matsubara, Oscar Teramoto; Tawil, José; Vallejo-Soto, M.; Sáez-Ríos, A.; Vargas-Romero, J.A.; Zarate-Guzmán, Ángel M.; Galvis-García, E.S.; Morales-Arámbula, M.; Quiroz-Castro, Oscar; Carrasco-Rojas, Antonio; Remes-Troche, José María

doi:10.1016/j.rgmxen.2017.02.001

Cited by 10 publications

(15 citation statements)

References 84 publications

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“…These findings are congruent with systematic reviews that have demonstrated that Nissen fundoplication leads to higher rates of postoperative dysphagia than Toupet fundoplication (89% vs 11%, p<0.01) [23].Further, the percentage of patients who required endoscopic dilation to palliate dysphagia (10.3%) is similar to that reported in the literature [9] [12] [24] [25]. Sobrino et al [24] reported one case series in which 12.4% of the patients who underwent gastroesophageal fundoplication required from 1 to 5 dilations to provide some relief of postoperative dysphagia.…”

Section: Discussionsupporting

confidence: 89%

“…Hui et al [9] reported good clinical response in dysphagia patients after balloon pneumatic dilation (64% of patients experienced symptomatic relief). However, the literature shows dilation for post-fundoplication dysphagia achieves variable resolution between 50%-67% [19] [24]. Here, symptomatic relief of symptoms for more than 6-weeks after pneumatic dilation was observed in 36.6%.…”

Section: Discussionmentioning

confidence: 85%

“…Studies have also shown that the use of dilations can be beneficial for patients helping them avoid another operation [24]. Pneumatic dilations alleviate dysphagia symptoms in a majority of patients while reducing the number of patients requiring revision.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 85%

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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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“…Essentially, it can lead to the malfunctioning gastroesophageal barrier leading to esophageal acid reflux. The postfundoplication ambulatory pH testing can be performed to assess physiologic characteristics of the gastroesophageal junction [25]. In our case, the optimal acid control was achieved after fundoplication, as evaluated by ambulatory pH monitoring.…”

Section: Discussionmentioning

confidence: 89%

Frequent Sips of the Water for the Management of Gastroesophageal Reflux Induced Refractory Cough: A Case Report and Review of the Literature

Tariq¹,

Makker²,

Ahmed³

et al. 2019

Case Reports in Gastrointestinal Medicine

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Background. Chronic cough is often associated with gastroesophageal reflux disease (GERD). The role of gastroenterologist in the management of the chronic cough is to identify and manage GERD. Ineffective esophageal motility is often associated with GERD induced cough. Chronic cough is often refractory to medical and surgical management despite adequate acid control. Unresponsiveness warrants a thorough pulmonary evaluation. The pathophysiology of refractory cough in these patients is poorly understood, and hence management is often challenging. Case Presentation. A 75-year-old woman from Ghana was evaluated for GERD associated chronic cough. A 48-hour ambulatory pH study revealed acid exposure of 4.9% and high-resolution manometry showed decreased lower esophageal sphincter pressure, an inadequate response to medical and surgical management of GERD. Postfundoplication ambulatory pH testing demonstrated well-controlled acid reflux but her cough still persisted. Repeat manometry showed an ineffective motility disorder (IEM). Taking frequent sips of water eventually resolved her chronic cough. Conclusion. Frequent sips of water can be used in the management of the gastroesophageal reflux and ineffective motility induced cough. It results in increased esophageal clearance of acid, nonacid reflux, and ingested pharyngeal secretions, thus breaking the cycle of cough generated increased intra-abdominal pressure with reflux and more cough.

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“…One key function is to release air from the stomach in the form of belching. The ability to vent excess gas pressure from the stomach is important to normal human physiology, as evidenced by the development of gas‐bloat syndrome in some patients following Nissen fundoplication (Sobrino‐Cossío et al, 2017). The fundoplication procedure, which is used to treat GERD, involves wrapping part of the stomach around the GEJ to prevent reflux.…”

Section: Neuromuscular Physiologymentioning

confidence: 99%

Tissue engineering of the gastroesophageal junction

Vogt

Panoskaltsis‐Mortari

2020

J Tissue Eng Regen Med

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Post-fundoplication symptoms and complications: Diagnostic approach and treatment

Cited by 10 publications

References 84 publications

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

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

Frequent Sips of the Water for the Management of Gastroesophageal Reflux Induced Refractory Cough: A Case Report and Review of the Literature

Tissue engineering of the gastroesophageal junction

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