Selection of Patients for Laparoscopic Antireflux Surgery

Abstract

Since the first laparoscopic fundoplication was performed, the frequency of antireflux surgery has increased rapidly with some centers now having an experience of about 1,000 procedures. The question arises whether this increase is due to a change in indications for the surgical treatment of gastrointestinal reflux disease (GERD) despite the simultaneous appearance of powerful antisecretory medications. Adequate knowledge of the pathophysiology of GERD is necessary in order to establish selection criteria for patients suitable for laparoscopic antireflux surgery. In this article, we review the epidemiology and pathophysiology, and provide a rationale for medical and surgical treatment. We also offer an approach to patient selection for antireflux surgery.

Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

“…This results in an increase of esophageal mucosal injuries and subsequent complications. Therefore, a more aggressive treatment has been advocated in these patients [3] . However, a higher morbidity and mortality of open surgery in the elderly, limited the number of these patients referred for surgical treatment.…”

The Nissen fundoplication: indication, technical aspects and postoperative outcome

“…Even in the study by Fibbe et al, although it was concluded that Nissen fundoplication does not cause more dysphagia than partial posterior fundoplication, a careful look at the data reveals that the rate of dysphagia is, indeed, significantly higher after the Nissen than after partial posterior fundoplication especially when performed in patients with preoperatively impaired oesophageal peristalsis [63]. For all this we emphasise partial posterior fundoplication in all patients with weak peristalsis [67].…”

Tratamento cirúrgico da doença de refluxo gastroesofágico na esclerose sistêmica

“…Em termos de relação risco/benefício, o risco de uma evolução desfavorável após uma cirurgia laparoscópica é maior que aquele observado com o tratamento de manutenção com os inibidores da bomba protônica, tornando necessária uma seleção cuidadosa dos pacientes a serem considerados para cirurgia (35,36) . A evolução dos pacientes selecionados para cirurgia anti-refluxo tem demonstrado melhora na qualidade de vida no seguimento a longo prazo (9) , e quando comparado ao tratamento não cirúr-gico (37,38) .…”