When Fundoplication Fails

Smith, C. Daniel; McClusky, David A.; Rajad, Murad Abu; Lederman, Andrew; Hunter, John G.; Richards, William O.; Jobe, Blair A.; Richardson, J. David; Rege, Robert V.

doi:10.1097/01.sla.0000165198.29398.4b

Cited by 177 publications

(121 citation statements)

References 18 publications

(16 reference statements)

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“…They found that 34% had symptomatic relapse, and many of them required medical management [15]. Smith and colleagues followed a cohort of 1892 patients for 10 years post fundoplication and found that 17% had resumed using antisecretory medications [16]. Spechler and colleagues followed a cohort of 38 patients for 10 years after fundoplication and found that 62% were using antisecretory medications [17].…”

Section: Myth: Fundoplication Effectively Controls Reflux Symptomsmentioning

confidence: 99%

Stretta Radiofrequency Treatment for GERD: A Safe and Effective Modality

Franciosa

Mashimo²

2013

American Journal of Gastroenterology

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Gastroesophageal reflux disease is one of the leading gastrointestinal disorders. Current treatments include lifestyle modifications, pharmacological therapies, surgical fundoplications, and, more recently, endoscopic procedures. The rising concern of longterm side effects of the popular proton-pump inhibitors and the more recent evidence raising doubts about the durability of fundoplication have spurred reinterest in endoscopic procedures to treat reflux disorders. In the aftermath of several innovative antireflux procedures that were introduced and failed clinically or financially over the past decade, there is lingering confusion regarding the merits of the presently available interventions. This paper focuses on one endoscopic procedure, Stretta, which now enjoys the longest experience, a recent meta-analysis, and robust data supporting its safety, efficacy, and durability. Stretta reduces esophageal acid exposure, decreases the frequency of transient lower esophageal relaxation, increases patient satisfaction, decreases medication use, and improves quality of life. As such, this procedure remains a valuable nonsurgical treatment option in the management of gastroesophageal reflux disease.

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Section: Myth: Fundoplication Effectively Controls Reflux Symptomsmentioning

confidence: 99%

Stretta Radiofrequency Treatment for GERD: A Safe and Effective Modality

Franciosa

Mashimo²

2013

American Journal of Gastroenterology

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“…[10][11][12] In a series of 307 re-do fundoplications, Smith et al 6 found that fundoplication herniation was the most common mechanism of failure. Symptomatic patients with objective evidence of failure of LARS can be offered re-do surgery: several studies have demonstrated that this can be safely undertaken laparoscopically.…”

Section: Ann R Coll Surg Engl 2010; 92: 131-135 131mentioning

confidence: 99%

“…Failure rates of laparoscopic Nissen fundoplication vary from 2% to 30%, [3][4][5][6][7] depending on the definition of 'failure'. Both patients and clinicians may interpret resumption of medical treatment as failure, but the majority of patients taking antireflux medication are taking it for atypical or non-reflux related symptoms.…”

mentioning

confidence: 99%

Anatomical failure following laparoscopic antireflux surgery (LARS); does it really matter?

Dunne

Stratford²,

Jones³

et al. 2010

annals

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Ann R Coll Surg Engl 2010; 92: 131-135 131Correction of the physiological factors contributing to gastrooesophageal reflux disease (GORD) is only possible by surgical fundoplication and, since the advent of laparoscopic fundoplication by Dallemagne et al. in 1991, 1 is an increasingly attractive option for patients due to low morbidity and greatly reduced length of hospital stay. As a result, laparoscopic antireflux surgery (LARS) has become the gold standard in the surgical treatment of GORD. Lundell et al. 2 reported a 7-year follow-up comparing results in patients randomised to proton-pump inhibition or open antireflux surgery, and surgery was shown to be more effective at controlling overall disease symptoms, but post-fundoplication complaints were problematic.Failure rates of laparoscopic Nissen fundoplication vary from 2% to 30%, 3-7 depending on the definition of 'failure'. Both patients and clinicians may interpret resumption of medical treatment as failure, but the majority of patients taking antireflux medication are taking it for atypical or non-reflux related symptoms.7-9 An anatomical explanation for failed reflux surgery can often be found, such as breakdown of the fundoplication, an over-tight wrap, intrathoracic herniation of the wrap or telescoping of the lower oesophageal sphincter through the wrap. [10][11][12] In a series of 307 re-do fundoplications, Smith et al. 6 found that fundoplication herniation was the most common mechanism of failure. Symptomatic patients with objective evidence of failure of LARS can be offered re-do surgery: several studies have demonstrated that this can be safely undertaken laparoscopically.6,13-16 Donkervoort et al. 17 studied anatomical wrap position and the outcome following laparoscopic Nissen fundoplication and, 2 years' postoperatively, found that the anatomical repair failed in 27% using 'strict' criteria A degree of anatomical failure is common, and the most common failure is intrathoracic wrap herniation. We have assessed anatomical integrity of the crural repair and wrap using marking Liga clips placed at the time of surgery and compared this with symptomatic outcome. PATIENTS AND METHODS A prospective study was undertaken on 50 patients who underwent LARS in a single centre over a 3-year period. Each had an X-ray on the first postoperative day and a barium swallow at 6 months at which the distance was measured between the marking Liga clips. An increase in interclip distance of > 25-49% was deemed 'mild separation', and an increase of > 50% 'moderate separation'. Patients completed a standardised symptom questionnaire at 6 months. RESULTS At 6 months' postoperatively, 22% had mild separation of the crural repair with a mean Visick score of 1.18, and 54% had moderate separation with a mean Visick score of 1.26. Mild separation of the wrap occurred in 28% with a mean Visick score of 1.21 and 22% moderate separation with a mean Visick score of 1.18. Three percent had mild separation of both the crural repair and wrap with a mean Visick score of 1.0, ...

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“…Patient satisfaction after laparoscopic Nissen fundoplication with 5-year follow-up is 86-96% (Lafullarde et al, 2001;Smith et al, 2005). Complications associated with laparoscopic hiatal hernia surgery include stenosis, pulmonary complications (pneumonia, pneumothorax, pulmonary edema) and gastrointestinal complications (bleeding, perforation, dysphagia).…”

Section: Laparoscopic Repairmentioning

confidence: 99%

“…Complications occur in approximately 15%, slightly increasing with multiple redos. After redo laparoscopic fundoplication 70% of patients is GERD-related symptom free (Smith et al, 2005).…”

Section: Treatment Of Recurrencementioning

confidence: 99%