Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication

Chrysos, Emmanuel; Tzortzinis, Anastasios; Tsiaoussis, John; Athanasakis, Helias; Vasssilakis, John-Sophocles; Xynos, Evaghelos

doi:10.1016/s0002-9610(01)00695-x

Cited by 90 publications

(70 citation statements)

References 25 publications

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“…Although no study has formally implicated division of short gastric vessels as a risk factor for delayed gastric empting, several randomized trials and meta‐analyses have found that routine division of short gastric vessels during laparoscopic fundoplication is associated with higher rates of postprandial bloating22, 23, 24, which may reflect delayed gastric emptying. Despite the rationale that division of short gastric vessels may facilitate the creation of a tension‐free fundoplication and minimize the risk of postoperative dysphagia25, multiple studies26, 27, 28, 29 have demonstrated that this intraoperative manoeuvre does not influence swallowing outcomes after antireflux surgery.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

et al. 2017

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BackgroundDelayed gastric emptying can complicate surgery for hiatus hernia. The aim of this study was to quantify its incidence following laparoscopic repair of very large hiatus hernias, identify key risk factors for its occurrence and determine its impact on clinical outcomes.MethodsData collected from a randomized trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (more than 50 per cent of stomach in chest) were analysed retrospectively. Delayed gastric emptying was defined as endoscopic evidence of solid food in the stomach after fasting for 6 h at 6 months after surgery.ResultsDelayed gastric emptying occurred in 19 of 102 patients (18·6 per cent). In univariable analysis, type 2 paraoesophageal hernia (relative risk (RR) 3·15, 95 per cent c.i. 1·41 to 7·06), concurrent anterior and posterior hiatal repair (RR 2·66, 1·14 to 6·18), hernia sac excision (RR 4·85, 1·65 to 14·24), 270°/360° fundoplication (RR 3·64, 1·72 to 7·68), division of short gastric vessels (RR 6·82, 2·12 to 21·90) and revisional surgery (RR 3·69, 1·73 to 7·87) correlated with delayed gastric emptying. In multivariable analysis, division of short gastric vessels (RR 6·27, 1·85 to 21·26) and revisional surgery (RR 6·19, 1·32 to 28·96) were independently associated with delayed gastric emptying. Delayed gastric emptying correlated with adverse gastrointestinal symptomatology, including higher rates of bloating, nausea, vomiting and anorexia, as well as reduced patient satisfaction with the operation and recovery.ConclusionDelayed gastric emptying following large hiatus hernia repair is common and associated with adverse symptoms and reduced patient satisfaction. Division of short gastric vessels and revisional surgery were independently associated with its occurrence.

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Section: Discussionmentioning

confidence: 99%

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

et al. 2017

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“…Moreover, another study with 56 patients compared phmetric, manometric, endoscopic and contrast-enhanced radiography data and revealed no signifi cant difference between groups. After 12 months, dysphagia and recovery from GERD were similar in both groups, although patients that underwent SGV division presented more gas bloating complaint 18 . However, none of the reported studies had a uniform technique of SGV division with harmonic scalpel (group B) and gastric fundus mobilization using posterior and anterior wall (group A) for the fundoplication, one of the most important differences of our study.…”

Section: Discussionmentioning

confidence: 79%

“…Despite the fact that we used the harmonic scalpel for SGV division in every procedure, this group had higher procedure duration. All three randomized clinical trials (RCT) also revealed longer procedure time in the SGV division groups 16,17,18 . We must emphasize that the extended gastric mobilization including division of all SGV and adhesions of the posterior wall as proposed by DeMeester et al 4 was reposted only in our study.…”

Section: Discussionmentioning

confidence: 98%

“…The randomized clinical trials (RCT) during laparoscopic era present now different standards of technique: the mobilization extension, number of divided vessels and the technique to make those divisions. Watson et al 16 , used metallic staples; other techniques included monopolar cauterization and harmonic scalpel 17,18 . When the SGV were not divided, the anterior wall of gastric fundus was used for the fundoplication, and not the posterior wall 16,17,18 .…”

Section: Introductionmentioning

confidence: 99%

“…Watson et al 16 , used metallic staples; other techniques included monopolar cauterization and harmonic scalpel 17,18 . When the SGV were not divided, the anterior wall of gastric fundus was used for the fundoplication, and not the posterior wall 16,17,18 . A metanalysis published by Catarci et al 19 concluded that the routine division of SGV had no advantage.…”

Section: Introductionmentioning

confidence: 99%

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Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

et al. 2007

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PURPOSE: Evaluate short results after fundoplication procedure, concerning the division of short gastric vessels. METHODS: A prospective randomization of 90 patients with indication for hiatoplasty and total fundoplication with fundus mobilization was performed. They were divided into two groups: no SGV division (group A, n= 46) and with SGV division (Group B, n=44), although in both groups the gastric fundus was mobilized to perform a floppy valve. Early outcome with clinical follow up (1 year) was observed. RESULTS: Both groups were similar regarding preoperative parameters and severity of gastroesophageal reflux disease (GERD). No difference in morbidity was observed during hospital stay. Nevertheless, the median operating time was 80,2 minutes in group A and 94,1 minutes (p=0,021) in Group B. Transitory dysphagia during the first year was significantly lower in group B (46,6% versus 23,2%, p=0,012). However, in 12 months clinical outcome was similar in both groups (clinical symptoms of GERD, persistent dysphagia and reoperations). CONCLUSION: There was no improvement in routine division of SGV in total fundoplication procedure when the gastric fundus was mobilized.

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Laparoscopic Antireflux Surgery

Pessaux

Arnaud²,

Delattre³

et al. 2005

Arch Surg

122

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Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication

Cited by 90 publications

References 25 publications

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

Risk factors for delayed gastric emptying following laparoscopic repair of very large hiatus hernias

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

Laparoscopic Antireflux Surgery

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