Reflux und Hiatushernie im Spannungsfeld zwischen konservativer und operativer Therapie

Freys, Stephan M.; Heimbucher, J.

doi:10.1007/s00104-014-2804-0

“…Esophageal hiatal hernia is frequently associated with gastroesophageal reflux disease (GERD) [1]. Gastroesophageal reflux disease affects 40% of the population in industrialized countries [1], has a high incidence, and without adequate treatment can generate complications that are difficult to manage [1] [2] [3].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Quality of Life in Pre- and Post-Operatory in Patients Submitted to Surgical Treatment of Reflux Disease and Hiato Hernia

Madureira¹,

Filho²,

Galvão³

2023

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Gastroesophageal reflux disease affects 40% of the population in industrialized countries. GERD has a negative impact on the quality of life of affected patients. Although PPIs induce a good response in the control of symptoms, the need for prolonged use of the medication and the fact that more than a third of the patients have symptoms even after its correct use, make surgery, an alternative for the treatment of the disease. The aims of this study were to compare the quality of life related to GERD before and after MIS surgical treatment of GERD and/or hiatus hernia, and to analyze the results and complications of the MIS treatment of GERD. Methods: For retrospective analysis, the electronic database of patients with indications for surgical treatment due to GERD and/or patients with sliding or paraesophageal hernias was examined. The study included patients from Hospital Universitário Gaffrée e Guinle and the Postgraduate Course in General Surgery at PUC-Rio (Rio de Janeiro, Brazil) who underwent surgery using video laparoscopy or robotic surgery between January 2013 and March 2020. This is an observational, longitudinal, descriptive study with retrospective analysis of the data. Surgical treatment was indicated due to incomplete response to clinical treatment, young age with persistent symptoms, or complications of GERD. Patients with hiatus and/or paraesophageal hernia with indication for surgical treatment were included. Results: The study evaluated 160 patients who underwent anti-reflux surgery by laparoscopic or robotic surgery in the period from 2013 to 2020. A total of 88 women and 72 men were operated, mean 46.6 ± 13.7 years. An improvement in the preoperative QS-GERD scores compared to the postoperative scores was observed (27.56 ± 10.93 vs 1.4 ± 2.47, p < 0.

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A retrospective analysis of the efficiency of intraoperative high-resolution manometry was conducted to examine the life satisfaction of patients before and after surgery for reflux disease and a hiatal hernia

Saad,

Baz,

Farid

et al. 2023

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Traditional manometry-based studies in the past revealed two separate pressure zones in HH patients at the EGJ level, indicating the patial separation of LES and CD; however,they were unable to attain optimal sensitivity. High-resolution manometry (HRM) can accurately determine the differences between CD and LES and evaluate their anatomical relationships. Three EGJ subtypes were described by HRM and determind using LES-CD distinction. However, few studies have been conducted too determine the precision of the diagnosis. The affected individuals' GERD-standard lifestyle is impaired by reflux complications. An operation is a possible option for the cure of illnesses, even though PPIs produce a significant improvement in the management of difficulties owing to the requirement for continued use of the drug and the reality that over three per cent of these individuals still experience problems despite proper use . The objectives of this study were to evaluate the outcomes and side effects of MIS therapy for GERD and asssess the satisfaction of existence associated with GERD before and after GERD and/or hiatus hernia surgery. In addition ,we assessed the diagnostic accuracy of high-resolution manometry in detecting hiatal hernia compared to esophagogram and esophagogastroduodenoscopy, using surgical in vivo measurement as a reference. Methods: Computerized records of individuals with GERD who underwent surgery and/or individuals with sliding or paraesophageal hernias were analyzed in this retrospective study. Individuals who underwent laparoscopy at the Zagazig University Hospital between January 2016 and March 2023 participated in the study. This research was observational, longitudinal, descriptive, and included retrospective data analysis. Surgery was recommended because of poor response to medical therapy, young age, prolonged indicators, or GERD consequences. During surgery, there were 100 cases, and 53 (53%) patients had HHs. Forty-seven (47%) patients were classified as type I EGJ, 35 (35%) as type II, and 18 (18%) as type III EGJ, as examined by manometry (HRM) esophagogram, and EGD. Results: From 2016 to 2023, 320 patients who underwent laparoscopic anti-reflux surgery were examined .The mean age of the 176 women and 144 men who underwent surgery was 46.6± 13.7 years. Before surgery, QS-GERD scores improved compared to post-surgery scores (27.56 10.93 vs. 1.4 2.47, p 0.01). Furthermore, it was discovered that none of the following factors sex, age, body mass index, surgical method, or the number of stitches on the fundoplication valve—were associated with a poorer outcome or failure probability. With a global median of 24 hours and a mean of 28.7 hours, the average hospitalisation was 24 hours for 74.2% of individuals, 48 hours for 19.3%, and 72 hours for 4.6%. There were no initial surgical problems (such as seroma, infections of the wounds, or eventration) or deaths, and no patients who needed blood transfusions were not required. The effectiveness of intraoperative manometry was evaluated in all 100 patients. The kappa values for high-resolution manometry and in vivo evaluation were 0.85. High-resolution manometry showed optimal sensitivity and specificity in detecting type I, II, and III esophagogastric junctions compared to endoscopy and esophageal. Conclusions: summarise the body of knowledge that exists on this topic 1-Sliding HH presence has been linked to aberrant esophageal acid exposure, extended esophageal clearance, and a rise in reflux episodes. It is more frequently observed when the GERD becomes more severe. 2-Barium swallow esophagogram and EGD can both be used to diagnose HHs, although these two techniques are hampered by the subjective and oblique evaluation of EGJ components 3-In the treatment of GERD patients, a more accurate diagnostic assessment of HH presence and axial dislocation may be helpful.

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Examining the life satisfaction of pre-and post-operative results of surgery for reflux disease and a hiatal hernia included a retrospective evaluation of intraoperative high- resolution manometry effectiveness

Saad,

Baz,

Farid

et al. 2023

Preprint

0

View full text Add to dashboard Cite

Traditional manometry-based studies in the past revealed two separate pressure zones in HH patients at the EGJ level, indicating the patial separation of LES and CD; however,they were unable to attain optimal sensitivity. High-resolution manometry (HRM) can accurately determine the differences between CD and LES and evaluate their anatomical relationships. Three EGJ subtypes were described by HRM and determind using LES-CD distinction. However, few studies have been conducted too determine the precision of the diagnosis. The affected individuals' GERD-standard lifestyle is impaired by reflux complications. An operation is a possible option for the cure of illnesses, even though PPIs produce a significant improvement in the management of difficulties owing to the requirement for continued use of the drug and the reality that over three per cent of these individuals still experience problems despite proper use . The objectives of this study were to evaluate the outcomes and side effects of MIS therapy for GERD and asssess the satisfaction of existence associated with GERD before and after GERD and/or hiatus hernia surgery. In addition ,we assessed the diagnostic accuracy of high-resolution manometry in detecting hiatal hernia compared to esophagogram and esophagogastroduodenoscopy, using surgical in vivo measurement as a reference. Methods: Computerized records of individuals with GERD who underwent surgery and/or individuals with sliding or paraesophageal hernias were analyzed in this retrospective study. Individuals who underwent laparoscopy at the Zagazig University Hospital between January 2016 and March 2023 participated in the study. This research was observational, longitudinal, descriptive, and included retrospective data analysis. Surgery was recommended because of poor response to medical therapy, young age, prolonged indicators, or GERD consequences. During surgery, there were 100 cases, and 53 (53%) patients had HHs. Forty-seven (47%) patients were classified as type I EGJ, 35 (35%) as type II, and 18 (18%) as type III EGJ, as examined by manometry (HRM) esophagogram, and EGD. Results: From 2016 to 2023, 320 patients who underwent laparoscopic anti-reflux surgery were examined .The mean age of the 176 women and 144 men who underwent surgery was 46.6± 13.7 years. Before surgery, QS-GERD scores improved compared to post-surgery scores (27.56 10.93 vs. 1.4 2.47, p 0.01). Furthermore, it was discovered that none of the following factors sex, age, body mass index, surgical method, or the number of stitches on the fundoplication valve—were associated with a poorer outcome or failure probability. With a global median of 24 hours and a mean of 28.7 hours, the average hospitalisation was 24 hours for 74.2% of individuals, 48 hours for 19.3%, and 72 hours for 4.6%. There were no initial surgical problems (such as seroma, infections of the wounds, or eventration) or deaths, and no patients who needed blood transfusions were not required. The effectiveness of intraoperative manometry was evaluated in all 100 patients. The kappa values for high-resolution manometry and in vivo evaluation were 0.85. High-resolution manometry showed optimal sensitivity and specificity in detecting type I, II, and III esophagogastric junctions compared to endoscopy and esophageal.

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Reflux und Hiatushernie im Spannungsfeld zwischen konservativer und operativer Therapie

Cited by 3 publications

References 27 publications

Evaluation of the Quality of Life in Pre- and Post-Operatory in Patients Submitted to Surgical Treatment of Reflux Disease and Hiato Hernia

Evaluation of the Quality of Life in Pre- and Post-Operatory in Patients Submitted to Surgical Treatment of Reflux Disease and Hiato Hernia

A retrospective analysis of the efficiency of intraoperative high-resolution manometry was conducted to examine the life satisfaction of patients before and after surgery for reflux disease and a hiatal hernia

Examining the life satisfaction of pre-and post-operative results of surgery for reflux disease and a hiatal hernia included a retrospective evaluation of intraoperative high- resolution manometry effectiveness

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