Role of laparoscopic fundoplication in the management of gastro-esophageal reflux disease: An evidence-based appraisal

Gastro-esophageal reflux disease (GERD) is a very common medical disease. There is no consensus for optimal management of GERD. Proton pump inhibitors (PPI) are the most effective drug treatment for GERD. The number of antireflux procedures is on the rise, partly due to increased patient’s expectations, and partly due to the advancements in minimal access surgery. There are few controversies surrounding role of laparoscopic fundoplication in the management of GERD, like whether surgery is superior to PPI; which modality is better, laparoscopic or open; whether complete wrap is better than partial, and whether division of short gastric vessels provides any advantage or not. This review article was undertaken to evaluate the role of laparoscopic fundoplication in the management of GERD and to find out answers to these controversial questions.     

Mid and long term results in the laparoscopic surgical treatment of gastroesophageal reflux

AIM: The advent of laparoscopic surgery produced a new interest in the surgical treatment of many benign and functional gastrointestinal diseases; one of the most commonly treated is the gastroesophageal reflux disease (GERD). In this paper the Authors report their 15 years experience in the laparoscopic surgical management of GERD. METHODS: From October 1991 to June 2005, 581 patients with GERD were treated by a laparoscopic fundoplication with a 360 degrees wrap (524 cases) or with a 270 degrees wrap (29 cases) or with a Collis gastroplasty (28 cases). RESULTS: The absence of intraoperative mortality, a low conversion to open surgery (0.7%) and a low postoperative morbidity (2.4%) with good clinical and instrumental long term results let the Authors to think that GERD represent an ideal indication for laparoscopic surgery. CONCLUSIONS: Good results are possible in the laparoscopic management of GERD with a precise selection of patients and with a good open and laparoscopic surgical experience in the management of functional esophageal diseases.     

Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease

BackgroundGastroesophageal reflux disease (GERD) is commonly associated with morbid obesity. Laparoscopic fundoplication is a standard surgical treatment for GERD, and laparoscopic gastric bypass has been shown to effectively resolve GERD symptoms in the morbidly obese. We sought to compare the in-hospital outcomes of morbidly obese patients who underwent laparoscopic fundoplication for the treatment of GERD versus laparoscopic gastric bypass for the treatment of morbid obesity and related conditions, including GERD, at U.S. academic medical centers.MethodsUsing the “International Classification of Diseases, 9th Revision” procedural and diagnoses codes for morbidly obese patients with GERD, we obtained data from the University HealthSystem Consortium database for all patients who underwent laparoscopic fundoplication or laparoscopic gastric bypass from October 2004 to December 2007 (n = 27,264). The outcome measures included the patient demographics, length of stay, in-hospital overall complications, mortality, risk-adjusted mortality ratio (observed to expected mortality), and hospital costs.ResultsCompared with the patients who underwent laparoscopic gastric bypass, those who underwent laparoscopic fundoplication had a lower severity of illness score (P <.05). The overall in-hospital complications were significantly lower in the laparoscopic gastric bypass group (P <.05). The mean length of stay, observed mortality, risk-adjusted mortality, and hospital costs were comparable between the 2 treatment groups.ConclusionLaparoscopic gastric bypass is as safe as laparoscopic fundoplication for the treatment of GERD in the morbidly obese. Hence, morbidly obese patients with GERD should be referred for bariatric surgery evaluation and offered laparoscopic gastric bypass as a surgical option.     

Does Barrett's esophagus impact outcome after laparoscopic Nissen fundoplication?

BACKGROUND: This study was undertaken to compare patients with gastroesophageal reflux disease (GERD) with or without Barrett's esophagus for severity and frequency of symptoms and their response to antireflux surgery. METHODS: Eighty patients with GERD and Barrett's esophagus and 93 concurrent patients with GERD alone, all of whom underwent laparoscopic Nissen fundoplication, were compared by using symptom scores graded by a Likert scale. RESULTS: Before fundoplication, patients with Barrett's esophagus had higher DeMeester scores. Symptom scores were not different for patients with versus without Barrett's esophagus before or after laparoscopic Nissen fundoplication. CONCLUSIONS: Before and after fundoplication, patients with Barrett's esophagus, despite more severe reflux, have symptoms nearly identical in frequency and severity when compared with patients with GERD alone. Regardless of presence of Barrett's, all improve dramatically with laparoscopic Nissen fundoplication. Barrett's esophagus does not impact presentation before or outcome after laparoscopic Nissen fundoplication.     

Laparoscopic Fundoplication with or Without Pyloroplasty in Patients with Gastroesophageal Reflux Disease After Lung Transplantation: How I Do It

Introduction  

Several studies have confirmed that gastroesophageal reflux disease (GERD) in lung transplant patients is a risk factor for the development and progression of bronchiolitis obliterans syndrome (BOS), a form of rejection after lung transplantation. Moreover, numerous reports indicate that surgical correction of GERD may control the decline in lung function characteristic of BOS. Although laparoscopic fundoplication is an accepted treatment option for these patients with GERD, the surgical technique, which often includes a laparoscopic pyloroplasty, has not been standardized.     

Whether robot-assisted laparoscopic fundoplication is better for gastroesophageal reflux disease in adults: a systematic review and meta-analysis

Background  

Although laparoscopic fundoplication is an effective, minimally invasive surgical technique for gastroesophageal reflux disease (GERD) that failed to be treated with medicine, with wide implementation its technical limitations have become increasingly clear. Recently, robot-assisted laparoscopic fundoplication (RALF) was considered a new approach that makes up for the deficiency of conventional laparoscopic fundoplication (CLF). This systematic review aimed to assess the feasibility and efficiency of robot-assisted laparoscopic fundoplication for GERD.     

Assessment and management of gastroesophageal reflux disease following bariatric surgery

Gastroesophageal reflux disease (GERD) is a common disease in patients with obesity. The incidence of de novo GERD and the effect of bariatric surgery on patients with pre-existing GERD remain controversial. Management of GERD following bariatric surgery is complicated and can range from medical therapy to non-invasive endoscopic options to invasive surgical options. To address these issues, we performed a systematic review of the literature on the incidence of GERD and the various modalities of managing GERD in patients following bariatric surgery. Given the increased number of laparoscopic sleeve gastrectomy (LSG) procedures being performed and the high incidence of GERD following LSG, bariatric surgeons should be familiar with the options available to manage GERD following LSG as well as other bariatric procedures.     

Factors Associated with Increased Severity of Erosive Esophagitis 1 Year After Laparoscopic Sleeve Gastrectomy

Obesity Surgery - Weight reduction decreases gastroesophageal reflux disease (GERD), but laparoscopic sleeve gastrectomy (LSG) that damages the structure of the stomach may worsen GERD. We aimed to...     

Laparoscopic antireflux surgery in the lung transplant population

BACKGROUND: Lung transplantation has emerged as a viable therapeutic option for patients with a variety of end-stage pulmonary diseases. As immediate posttransplant surgical outcomes have improved, the greatest limitation of lung transplantation remains chronic allograft dysfunction. Gastroesophageal reflux disease (GERD) with resultant aspiration has been implicated as a potential contributing factor in allograft dysfunction. GERD is prevalent in end-stage lung disease patients, and it is even more common in patients after transplantation. We report here on the safety of laparoscopic fundoplication surgery for the treatment of GERD in lung transplant patients. METHODS: Eighteen of the 298 lung transplants performed at Duke University Medical Center underwent antireflux surgery for documented severe GERD. The safety and benefit of laparoscopic fundoplications in this population was evaluated. RESULTS: The antireflux surgeries included 13 laparoscopic Nissen fundoplications, four laparoscopic Toupets, and one open Nissen (converted secondary to extensive adhesions). Two of the 18 patients reported recurrence of symptoms (11%), and two others reported minor GI complaints postoperatively (nausea, bloating). There were no deaths from the antireflux surgery. After fundoplication surgery, 12 of the 18 patients showed measured improvement in pulmonary function (67%). CONCLUSIONS: GERD occurs commonly in the posttransplant lung population. Laparoscopic fundoplication surgery, when indicated, can be done safely with minimal morbidity and mortality. In addition to the resolution of reflux symptoms, improvement in pulmonary function may be seen in this population after fundoplication. Lung transplant patients with severe GERD should be strongly considered for antireflux surgery.     

Technical controversies in fundoplication surgery

Gastroesophageal reflux disease (GERD) is a common health problem affecting more than 50% of the population. For those who experience more than occasional symptoms, GERD has a profound effect on their quality of life. With the advent of laparoscopic surgery, fundoplication has been used to treat GERD. Fundoplication also is used in the surgical management of paraesophageal hernias. Technical controversies are addressed in this article, including open versus laparoscopic approaches, the choice of complete (360 degres) or partial fundoplication, whether or not a gastroplasty is required, and the use of prosthetic materials in crural repair.     

Endoscopic therapy for gastroesophageal reflux disease: can it replace antireflux surgery?

This article addresses emergent endoluminal technologies currently available for the treatment of gastroesophageal reflux disease (GERD) and compares it to the laparoscopic Nissen fundoplication. To date the mainstay of GERD therapy has been achieved with either open or laparoscopic fundoplication or life-long medical treatment. Endoluminal treatment modalities attempt to augment the gastroesophageal junction (GEJ) function by various techniques. We searched the Medline database from 1980 to 2004 for studies on endoscopic GERD techniques and laparoscopic fundoplications. Product investigators were contacted for data presented in abstract form only. Endoluminal management of GERD include using radiofrequency energy, injection of biocompatible polymers and endoluminal sutures to alter the GEJ and reduce reflux. Early results while encouraging, should be evaluated thoroughly and with caution before widespread use can be advocated. Endoscopic treatment of GERD has future promise, however, more experience and perhaps further refinement in techniques and technology must occur before widespread clinical application can be encouraged.     

Gastroesophageal reflux disease

Millions of Americans are affected by gastroesophageal reflux disease (GERD) in many different ways. The magnitude of the problem of GERD was brought to light by the ambulatory pH test, the introduction of minimally invasive surgery, and the advent of the many medications that are effective in acid suppression. Patients with GERD suffer from various consequences associated with the disease. However, interventions beyond medical therapy, such as laparoscopic fundoplication, provide satisfactory outcomes and definitive relief of acid reflux.     

Impact of Changing Epidemiology of Gastroesophageal Reflux Disease on its Diagnosis and Treatment

Gastroesophageal reflux disease (GERD) has emerged as one of the most common diseases in modern civilization. This article reviews selected changes in epidemiology of GERD during the past decade and provides information on treatment options with a focus on the impact of GERD and potential role of laparoscopic antireflux surgery in patients with diabetes mellitus, obesity, liver cirrhosis, at the extremes of life age and in immunocompromised individuals such as liver and lung transplant recipients.     

Laparoscopic Nissen fundoplication is less expensive than open Belsey Mark IV

Laparoscopic Nissen fundoplication is a relatively new technique used to treat gastroesophageal reflux disease (GERD). The purpose of this study was to compare the cost to the patient and insurer of a laparoscopic Nissen fundoplication (LN) to an open Belsey Mark IV (B4), the previous standard operation for GERD at Emory University Hospital.A retrospective review of 20 consecutive patients undergoing LN or B4 for GERD was performed. Patients were well matched for age, severity of disease, and comorbid illness. The data were analyzed using an unpaired Student's t-test or Wilcoxon signed rank analysis.The results are as follows (mean±SD):We conclude that the charges for laparoscopic Nissen fundoplication are significantly less than the charges for Belsey Mark IV. The majority of the savings resulted from a shortened hospital stay.     

腹腔镜抗反流手术治疗胃食管反流病对慢性阻塞性肺部疾病的影响

目的观察腹腔镜抗反流手术治疗胃食管反流病(GERD)对慢性阻塞性肺部疾病(COPD)的影响。方法收集2016年1月至2017年12月期间在郑州大学第一附属医院住院且采用腹腔镜抗反流手术治疗的20例GERD合并COPD患者,对所有患者采用反流诊断量表、肺功能、肺功能评估测试量表、24 h食管pH-阻抗监测和食管压力测定并对其结果作相关性分析。所有患者经保守治疗无效后选择腹腔镜下抗反流手术,12个月后完成随访,并再次对治疗前、后COPD和GERD相关参数结果进行对比,评价治疗效果。结果本组20例GERD患者均成功实施腹腔镜手术,无疝补片修补患者,无死亡病例,所有患者未发生食管破裂、出血、感染等术后严重并发症。术后8例患者出现不同程度的吞咽困难和10例出现不同程度的腹胀,均自行缓解。对20例GERD合并COPD患者在术后随访1年,无一例失访。与治疗前比较,治疗后患者的GERD症状评分、反流次数、DeMeester评分、COPD评估测试量表评分均明显降低(P<0.05),下食管括约肌压力、第1秒用力呼气容积(FEV1)占预计值百分率和FEV1/用力肺活量(FVC)均明显升高(P<0.05)。按照全球创议慢性阻塞性肺病分级标准,8例痊愈患者中5例Ⅰ级、2例Ⅱ级、1例Ⅲ级,9例改善患者中1例Ⅰ级、4例Ⅱ级、4例Ⅲ级,3例无效患者中1例Ⅰ级、1例Ⅱ级、1例Ⅳ级,总有效率85%(17/20)。结论 COPD与GERD密切相关,腹腔镜抗反流术的治疗不仅能治疗GERD,还可以明显改善COPD。     

The effect of bariatric surgery on gastroesophageal reflux disease

Obesity is an epidemic that is known to play a role in the development of gastro-esophageal reflux disease (GERD). Studies have shown that increasing body mass index plays a role in the incompetence of the gastroesophageal junction and that weight loss and lifestyle modifications reduce the symptoms of GERD. As a method of producing effective and sustainable weight loss, bariatric surgery plays a major role in the treatment of obesity. We reviewed the literature on the effects of different types of bariatric surgery on the symptomatic relief of GERD and its complications. Roux-en-Y gastric bypass was considered an effective method to alleviate symptoms of GERD, whereas laparoscopic sleeve gastrectomy appeared to increase the incidence of the disease. Adjustable gastric banding was seen to initially improve the symptoms of GERD; however, a subset of patients experienced a new onset of GERD symptoms during long-term follow-up. The literature suggests that different surgeries have different impacts on the symptomatology of GERD and that careful assessment may be needed before performing bariatric surgery in patients with GERD.     

Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

Gastroesophageal reflux disease(GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors(PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental(such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH /impedance-pH monitoring) and clinical features(such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.     

Laparoscopic Nissen fundoplication for reactive airway disease

Background: Surgical management for gastroesophageal reflux disease (GERD)-induced reactive airway disease in children has been shown to be superior to medical therapy. Laparoscopic Nissen fundoplication is a safe and effective procedure in children. Methods: The authors performed a retrospective review of 24 patients who underwent a laparoscopic Nissen fundoplication for documented GERD and reactive airway disease. Results: Persistent cough was the primary symptom in 22 of 24 patients, and all but one had lipid laden macrophages on bronchoscopy. The mean length of hospital stay was 2.7 days. There were no major postoperative complications. Eighteen of 24 patients are symptom free and off all medications an average of 17 months postoperatively. The average medication burden of the 6 remaining patients was reduced from 6.8 to 2.3 medications. Conclusions: Children with reactive airway disease who do not respond to medical therapy should undergo a workup for GERD. These preliminary results suggest that laparoscopic Nissen fundoplication is a potentially effective treatment for pulmonary manifestations of GERD. J Pediatr Surg 37:1021-1023.     

Laparoscopic Nissen fundoplication in situs inversus totalis: Technical and ergonomic issues

We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT). A 34-year-old man was diagnosed with SIT on performing chest X-ray and abdominal sonography as a routine preoperative investigations. He presented with chronic gastro-esophageal reflux disease (GERD) inadequately controlled by medications. The laparoscopic procedure was performed using five ports placed in a mirror-image configuration and with the patient in the modified lithotomy position. Few technical difficulties were encountered during the operation. The position of the primary surgeon, working between the lower limbs of the patient as in case of standard fundoplication, was considered most prudent position to the success of this case. In SIT, this position provides the least visual disorientation from the reversed abdominal organs. We recommend that preoperative detection of SIT is essential to understand the symptomatology of the patient and for planning of any upper abdominal laparoscopic procedure.     

Long-term results after laparoscopic Thal procedure in children

As the laparoscopic approach to gastroesophageal reflux disease (GERD) was introduced in pediatric surgery in the last decade of the 20th century, it became apparent that this approach was beneficial. The favorable results have led to a more general acceptance and implementation of this type of surgery at the beginning of the 21st century. We give an overview of the first decade of laparoscopic antireflux procedures in children with an emphasis on the laparoscopic Thal fundoplication and its implication on morbidity and cure of GERD in the long term both for normal and mentally handicapped children. Between 1993 and 2002, 149 children with GERD underwent 157 laparoscopic antireflux procedures, of whom 48% were mentally handicapped. Follow-up ranged from 6 months to 9 years (median age 4.5 years). Nineteen children died. All but one were not related to the antireflux procedure. Immediate relief of symptoms occurred in 120 children (80.5%). In 29 children, the results were less than optimal. Eight patients underwent a laparoscopic redo procedure (5.4%). However, none of the children with a follow-up of more than 5 years show any symptoms anymore. In conclusion, the laparoscopic Thal fundoplication is a safe procedure, and results in the long term are favorable, irrespective of the nature of the cause, ie, mental retardation.