Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes

Morgenthal, Craig B.; Lee, Edward; Shane, Matthew D.; Hunter, John G.; Smith, C. Daniel

doi:10.1007/s00464-007-9490-7

Cited by 231 publications

(149 citation statements)

References 32 publications

(46 reference statements)

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“…To date, few studies have examined the long-term efficacy and durability of traditional anti-reflux procedures such as Nissen fundoplication in the setting of severe obesity, and results have been conflicting [18][19][20][21][22] . It has been suggested that laparoscopic anti-reflux surgery is associated with a higher failure rate in obese patients because of intraoperative technical difficulties as well as increased intra-abdominal pressure postoperatively [28] . Nevertheless, others have reported equivalent outcomes in obese and normal weight individuals [17] .…”

Section: Discussionmentioning

confidence: 99%

“…The management of GORD in obese patients remains contentious with no consensus or published guidelines. Data are conflicting regarding the long-term efficacy of fundoplication in obese individuals compared with normal weight counterparts [18][19][20][21][22] . Nevertheless, most surgeons would agree that treatment of GORD in obese and non-obese patients requires different strategies [23] .…”

Section: Introductionmentioning

confidence: 99%

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Upper gastrointestinal surgeon attitudes towards management of refractory gastroesophageal reflux disease in obese patients

Al‐Khyatt¹,

Awad²,

Leeder³

2018

MIS

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Aim: The marked increase in prevalence of obesity has been associated with an increase in obese patients seeking surgical treatment for refractory gastroesophageal reflux disease (GORD). The management of GORD in such patients remains contentious with no published guidelines.Methods: A snapshot 9-item online survey was undertaken to elicit professional opinions of UK surgeons regarding the surgical management of refractory GORD in obese patients.Results: Eighty-two percent and 51% of surgeons performed more than 10 anti-reflux procedures and more than 10 bariatric procedures per year, respectively. Nearly 80 of responders would consider laparoscopic fundoplication as the preferred option for management of refractory GORD in patients with body mass index (BMI) of 30-34.9 kg/m 2 . In contrast, 58% and 80% would discuss bariatric surgery as an alternative treatment option for refractory GORD in patients with BMI 35-39.9 and ≥ 40 kg/m 2 , respectively. Moreover, a bariatric procedure was considered the preferred option by 74% of respondents for patients with BMI ≥ 40 kg/m 2 with refractory GORD, and by 58% for BMI ≥ 35 patients with refractory GORD and significant comorbidities. Eighty percent of surgeons agreed that laparoscopic Roux en-Y gastric bypass (LRYGB) was the preferred bariatric procedure for the management of obese patients with documented GORD. Conclusion:Our survey demonstrated that amongst UK upper gastrointestinal surgeons, bariatric surgery, specifically LRYGB, was a preferred option for management of patients with a BMI ≥ 35 kg/m 2 and refractory GORD. Updated national guidelines are necessary to inform consensus on the management of GORD in obese patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Upper gastrointestinal surgeon attitudes towards management of refractory gastroesophageal reflux disease in obese patients

Al‐Khyatt¹,

Awad²,

Leeder³

2018

MIS

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“…Although not unanimously, some series show poorer outcomes for obese patients [18,22] that undergo a fundoplication likely due to a more demanding operation with longer operative times [23] and more complications.…”

Section: Patient Selectionmentioning

confidence: 99%

“…[ [16][17][18][19] With the exception of obesity, these predictors cannot be changed in the majority of patients.…”

Section: Patient Selectionmentioning

confidence: 99%

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Preoperative workup, patient selection, surgical technique and follow-up for a successful laparoscopic Nissen fundoplication

Neto¹,

Herbella²

2017

MIS

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How to cite this article: Neto RML, Herbella FAM. Preoperative workup, patient selection, surgical technique and follow-up for a successful laparoscopic Nissen fundoplication. Mini-invasive Surg 2017;1:6-11. Quick Response Code: ReviewThis is an open access article licensed under the terms of Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author is credited and the new creations are licensed under the identical terms. For reprints contact: service@oaepublish.com Open AccessNeto et al. Mini-invasive Surg 2017;1:6-11 DOI: 10.20517/25741:6-11 DOI: 10.20517/ -12251:6-11 DOI: 10.20517/ .2016 Mini-invasive Surgery www.misjournal.netExperienced surgeons have reported excellent results for laparoscopic Nissen fundoplication to treat gastroesophageal reflux disease (GERD). Others, however, associate this operation with unacceptable rates of morbidity, mortality and inferior outcomes. Results are certainly linked to an appropriate patient selection, work up, technical details and follow-up. This review focuses on the proper preoperative workup, patient selection, surgical technique, and followup for a successful laparoscopic Nissen fundoplication. Certainty of the diagnosis of GERD and the esophageal physiology is essential. An extensive dissection of the esophagus and crus in the abdomen and mediastinum, an adequate hiatoplasty, and a short-floppy fundoplication are important technical points. New onset or persistent symptoms after the operation must be carefully studied. Excellent outcomes may be reproducible if a proper preoperative workup, patient selection, surgical technique and follow-up are rigorously observed. Key words:Gastroesophageal reflux disease, surgery, fundoplication, outcomes ABSTRACTArticle history:

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Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux

Maret-Ouda

Wahlin

El–Serag

et al. 2017

JAMA

109

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Who will fail laparoscopic Nissen fundoplication? Preoperative prediction of long-term outcomes

Cited by 231 publications

References 32 publications

Upper gastrointestinal surgeon attitudes towards management of refractory gastroesophageal reflux disease in obese patients

Upper gastrointestinal surgeon attitudes towards management of refractory gastroesophageal reflux disease in obese patients

Preoperative workup, patient selection, surgical technique and follow-up for a successful laparoscopic Nissen fundoplication

Association Between Laparoscopic Antireflux Surgery and Recurrence of Gastroesophageal Reflux

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