Nissen vs. toupet fundoplication in the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a serious phenomenon in pediatric health care. Without proper treatment, complications related to GERD can impede normal development and can lead to multiple hospitalizations and medical conditions. Previously, surgical intervention was limited to one technique, nissen fundoplication; however, the use of various forms of fundoplication surgery, primarily the toupet fundoplication, is currently increasing. Nurses need to be aware of treatment options and care of pediatric patients with severe GERD requiring surgical intervention, including common treatment modalities used prior to surgery and postoperative care necessary to promote positive results following fundoplication surgery.     

Enteral feeding in neurologically impaired children with gastroesophageal reflux: Nissen fundoplication and gastrostomy tube placement versus percutaneous gastrojejunostomy

Parents or caregivers of neurologically impaired children with gastroesophageal reflux who require enteral nutrition are often faced with the option of having their child undergo an antireflux surgery and placement of a gastrostomy tube or have a percutaneous gastrojejunostomy tube placed under fluoroscopic guidance. It is important that nurses have an understanding of these procedures and their associated risks and benefits as well as knowledge of the impact each might have on the daily life and care of these children to help support families during this decision-making process.     

Evaluation and treatment of gastroesophageal reflux in infants and children

Gastroesophageal reflux (GER), defined as passage of gastric contents into esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems encountered by both primary and specialty medical providers. Clinical manifestations of GERD in children include vomiting, poor weight gain, dysphagia, abdominal or substernal pain, esophagitis and respiratory disorders. On the other hand, recurrent vomiting is the symptom of hydronephrosis, brain tumor, food allergy, uremia, other metabolic disease, obstruction of intestine etc. It is very important for clinicians dealing with children and infants to understand GERD. The evaluation and treatment of gastroesophageal reflux in infants and children were reviewed here.     

Laparoscopic fundoplication for gastroesophageal reflux disease (GERD)

Laparoscopic fundoplication became the gold standard in the surgical therapy of GERD. In comparison with open procedures, laparoscopic antireflux surgery has a lower morbidity rate, a better early and late postoperative outcome and is more cost-effective. Antireflux surgery can be performed after a critical evalutation of the patient including gastroscopy, biopsy, 24h-pH-manometry and after a long lasting conservative medical treatment. Indications for antireflux surgery are given by a failed medical treatment, an insufficient compliance, complications of GERD, i.e. stenosis, Barrett-esophagus and atypical reflux symptoms like chronic cough, hoarseness or thoracic pain with presence of a pathological pH-monitoring. Laparoscopic 360 degrees Nissen-fundoplication with crurorrhaphy is our standard procedure, whereas the 270 degrees Toupet technique in our tailored approach is the technique of choice for esophageal motility disorders. Results of antireflux surgery published in literature are discussed and compared with our own ten years experience with 124 cases of laparoscopic fundoplication.     

机器人辅助外科达芬奇手术系统Nissen在胃底折叠治疗中的Meta分析

背景：与传统腹腔镜技术相比,机器人辅助外科特别是达芬奇手术系统可以提供良好的三维成像技术、更好的人体牛物工程学设计及更加精细的操作。目的：通过Meta分析评价机器人辅助外科达芬奇手术系统Nissen胃底折叠在治疗胃食管反流性疾病中的安全性及可行性。方法：运用计算机检索Embase、OVID及PubMed等数据库有关达芬奇系统辅助Nissen胃底折叠治疗胃食管反流性疾病的论文。根据数据类型不同,统计方法分别采用倒方差法和M．H法,并根据异质性分析结果分别采用随机效应模型和固定效应模型。结果与结论：共纳入5篇文献,累计160例患者。Meta分析结果显示,除术中及术后并发症外,传统腹腔镜组与机器人Nissen胃底折叠组总手术时间、有效手术时间、术后吞咽凼难发生率、中转开腹或中转为传统腹腔镜手术率、再手术率、住院时间及住院费用差异均无显著性意义（P〉0．05）。说明机器人Nissen胃底折叠在治疗胃食管反流行疚病时并不优于传统腹腔镜手术,因此应谨慎选择适应证。     

Ultrasound diagnosis of gastroesophageal reflux and hiatal hernia in infants and young children

In 30 young children suspected of gastroesophageal reflux (GER), the G-E junction was examined with ultrasonography directly after a feeding while these children were on overnight extended esophageal pH monitoring (EEpHM) (32 simultaneous ultrasound/EEpHM studies). The two tests showed 81% to 84% agreement in the detection of the presence or absence of GER, depending on whether the whole period of EEpHM or only the part of it covering the ultrasound observation period were used as the standard. The discrepancies between the two tests were explained by the much longer monitoring period of EEpHM compared to ultrasonography and the inability of EEpHM to show reflux of neutralized gastric contents directly after milk feedings. The two studies probably measure different aspects of clinically significant reflux and must be correlated with the clinical symptoms. Morphological findings associated with significant reflux were (1) a short intra-abdominal part of the esophagus, (2) a rounded gastroesophageal angle, and (3) a "beak" at the gastroesophageal junction. Barium meal findings confirmed these sonographic signs, indicating a sliding hiatal hernia of the distal esophagus, either fixed or intermittent. Ultrasonography can be recommended as a useful and physiological screening test to demonstrate clinically significant GER and a predisposing hiatal hernia of the esophagus in symptomatic children.     

Hiatal hernia with severe reflux esophagitis: treatment by superselective vagotomy and Nissen fundoplication

Thirty-two patients had surgical treatment for severe reflux esophagitis due to sliding hiatal hernia. A superselective vagotomy was done as an adjunct to a Nissen fundoplication as the antireflux procedure. All patients had severe esophagitis; 16 patients (53%) had dysphagia, nine patients (28%) had esophageal stricture, and all had failed an intensive trial of medical treatment with antireflux measures, antacids, and histamine receptor blockers. Follow-up averaged 14.3 months (3 to 38). Three patients (9%) had significant postoperative esophagitis. The other 29 patients, including those with esophageal stricture, are now asymptomatic. We conclude that the combination of a superselective vagotomy and a Nissen fundoplication is a safe and effective operation for the treatment of severe reflux esophagitis.     

Simple antireflux measures for management of gastroesophageal reflux disease

It is widely accepted that proton pump inhibitors are the most effective therapy for management of gastroesophageal reflux disease. H2-receptor antagonists, prokinetic agents, and antacids are used in treatment of gastroesophageal reflux disease. In addition to these medical treatments, beneficial effects of simple anti-reflux measures on management of gastroesophageal disease are evaluated. Simple anti-reflux measures include elevation of the head of the bed, weight loss, reduced food intake, and the avoidance of precipitating foods and drugs. In this chapter, we summarized the utility of these simple anti-reflux measures for management of gastroesophageal reflux disease.     

Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one-year follow-up

BACKGROUND AND STUDY AIMS: Quality of life data are becoming widely accepted as a measure of surgical outcome, but the multifaceted symptoms in patients with gastrointestinal disorders are a challenge for this type of evaluation. The aim of the present study was to determine any potential differences in quality of life, specifically in patients undergoing either laparoscopic "floppy" Nissen fundoplication or Toupet fundoplication. PATIENTS AND METHODS: Using the Gastrointestinal Quality of Life Index (GIQLI), the quality of life data for 175 consecutive patients undergoing laparoscopic "floppy" Nissen (n=107) or Toupet (n=68) fundoplication at our department of surgery over a period of 30 months were evaluated prospectively. The patients included 97 men and 78 women, with a mean age of 52 years. The GIQLI creates a general score for quality of life by classifying five different subscales: gastrointestinal symptoms, emotional status, physical and social functions, and stress of medical treatment. This questionnaire was given to the patients preoperatively, and on three occasions after surgery -- at six weeks, three months, and one year. RESULTS: The analysis showed that the patients had a low GIQLI preoperatively in comparison with healthy individuals (mean 90.4 vs. 122.6 points), with all subscales being affected. The general score improved significantly six weeks postoperatively (mean: 118.2 points; P<0.05), showed further improvement at three months (mean: 124.2 points), and remained stable at one year (mean: 123.1 points; P<0.01) postoperatively. There were no differences in the quality of life or side effects between patients with a Nissen or Toupet fundoplication, except regarding the frequency of mild, transient dysphagia. CONCLUSIONS: Patients with gastroesophageal reflux disease suffer from a poor quality of life. After laparoscopic fundoplication, the quality of life improves and becomes comparable to that of healthy individuals. In our view, quality of life data should be evaluated as a major factor in determining the role of surgical interventions. Patients should receive consultation and advice regarding quality of life questions prior to surgery.     

58例早产儿胃食管反流的护理干预

探讨预防早产儿胃食管反流(gastroesophageal reflux,GER)的护理方法,对我科收治的58例有胃食管反流的早产儿采取消化道护理、体位护理、抚触等护理干预,可有效减少早产儿的胃食管反流,患儿住院期间体重均有所增加,治疗好转出院。     

Care of the laparoscopic Nissen fundoplication patient.

Gastroesophageal reflux disease can usually be successfully managed with conservative medical treatment. Anti-reflux surgery is a safe alternative when treatment fails or patients desire a more definitive treatment option. Through a case study approach, this article describes the indications for surgery, the essentials of the authors' multi-disciplinary approach to care and the components of a well-designed education plan for a patient undergoing laparoscopic Nissen fundoplication. Although most patients do well after surgery, diligent nursing care is required before and after surgery to prevent or manage complications and ensure patients have a rapid recovery and successful outcome.     

Endoscopic suturing for gastroesophageal reflux disease: clinical outcome with the Bard EndoCinch

From a review of the single peer reviewed published report and the brief preliminary studies presented in abstract form, the BARD EndoCinch procedure seems safe and demonstrates an acceptable efficacy for symptom control during short-term follow-up. Most patients (about 2 out of 3) do well with improvement of GERD symptoms during the first post-procedural year. This benefit may wane over time. Objective benefit is lacking with the minority of treated individuals achieving normalization of 24-hour total acid exposure, and no significant effect has been seen in healing of esophagitis. This may focus the treatment towards that group of GERD patients with mild or non-erosive disease. The authors have no information that the endoscopic therapy could prevent reflux-related complications, and long-term data is awaited from accumulated clinical experience to establish the maintenance profile of this novel treatment. The outcomes from the sham trial, and long-term follow-up data will help to define the role of this anti-reflux therapy. The authors need additional studies to define the effect of endoluminal plication on the function of the lower esophageal sphincter to optimize its benefit for patients.     

重症肺炎儿童食管动力学的研究

目的 本研究的目的 在于确定重症肺炎儿童食管动力学的变化.方法 重症肺炎儿童25例(肺炎组)和正常儿童10例(对照组)进行连续食管pH监测和食管动力学监测,监测时间包括鼻饲前1小时和餐后3小时.结果 重症肺炎儿童胃食管反流(GER)发生率为84.0%(21/25);正常儿童GER发生率为20.0%,两组比较差异有统计学意义(χ2=12.990,P<0.01).重症肺炎组无效食管运动(IEM)发生率为72.0%(18/25),明显高于对照组(20.0%)(χ2=15.770,P＜0.01).结论 重症肺炎儿童胃食管反流发病率高,表现为酸反流次数增加,酸清除能力降低,与IEM增加有关,改善食管动力可能抑制重症肺炎儿童的反流.     

小儿胃食管反流的护理进展

从胃食管反流发生的相关危险因素、不同年龄段患儿临床表现及护理干预措施方面,综述了小儿胃食管反流的护理研究进展。     

Gastroesophageal reflux in infants and children.

Gastroesophageal reflux is a common, self-limited process in infants that usually resolves by six to 12 months of age. Effective, conservative management involves thickened feedings, positional treatment, and parental reassurance. Gastroesophageal reflux disease (GERD) is a less common, more serious pathologic process that usually warrants medical management and diagnostic evaluation. Differential diagnosis includes upper gastrointestinal tract disorders; cow's milk allergy; and metabolic, infectious, renal, and central nervous system diseases. Pharmacologic management of GERD includes a prokinetic agent such as metoclopramide or cisapride and a histamine-receptor type 2 antagonist such as cimetidine or ranitidine when esophagitis is suspected. Although recent studies have supported the cautious use of cisapride in childhood GERD, the drug is currently not routinely available in the United States.     

小儿胃食管反流诊治及护理进展

综述了小儿胃食管反流的临床表现、诊断以及治疗,并综合分析了保持呼吸道通畅,喂养指导,体位护理、健康教育等护理措施.     

Clinical presentation, diagnosis, and management of gastroesophageal reflux disease

GERD is ubiquitous throughout the adult population in the United States. It commonly adversely affects quality of life and occasionally causes life-threatening complications. The new and emerging medical and endoscopic therapies for GERD and the new management strategies for BE should dramatically reduce the clinical toll of this disease on society.