Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Fundoplication”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Laparoscopic Nissen fundoplication in children: a single surgeon's experience.

BACKGROUND AND OBJECTIVES: Adult laparoscopic Nissen fundoplication has been steadily growing since its introduction to the United States in the 1990s. Its advantage over the traditional open approach is manifold. Application of laparoscopic fundoplication to children is slowly but surely following this trend. This study evaluates our initial experience with pediatric laparoscopic Nissen fundoplications. PATIENTS AND METHODS: We reviewed the records of 25 consecutive laparoscopic Nissen fundoplications performed by a single surgeon (GS) at our institution in the past three years. The patient ages ranged from 7 months to 18 years (mean, 7 years). All patients had documented gastroesophageal reflux disease. Complications from the reflux included vomiting in 15 patients, failure to thrive in nine, esophagitis in nine, and pulmonary symptoms in six. RESULTS: All Nissen fundoplications were performed laparoscopically without need for conversion to open technique. Blood loss was less than 50 cc in all cases. A tube gastrostomy was concurrently performed in 17. Mean operative time in all cases was 221 minutes. Average postoperative day on which feedings were begun was day 2, with an average resumption of regular feedings on postoperative day 3.5. Average date of discharge was postoperative day 6.8. Complications included difficulty controlling glucose in an insulin-dependent diabetic, and a lost needle, which added an additional hour to the operative time. There were eight admissions to the pediatric intensive care unit, all for observation secondary to their underlying medical problems. There was one postoperative death due to an underlying medical condition. CONCLUSIONS: Laparoscopic Nissen fundoplication is a safe and effective treatment option for children suffering from significant reflux. Time to regular feeding, analgesia requirements and hospital stay are decreased when compared to traditional procedures. Laparoscopic Nissen fundoplication may well become the procedure of choice for pediatric gastroesophageal reflux disease.

Adolescent↗
PubMed2002

Symptoms and reflux competence in relation to anatomical findings at reoperation after laparoscopic total fundoplication.

OBJECTIVE: To investigate the mechanisms and anatomical failures after total laparoscopic fundoplication using the symptoms and findings at reoperation. DESIGN: Prospective open study. SETTING: University hospital, Sweden. PATIENTS: Twenty-one patients who were reoperated on a median of 33 (0.5-102) months after laparoscopic fundoplication. INTERVENTIONS: The patients were divided into three groups according to the mode of presentation. The first group presented with dysphagia and no gastro-oesophageal reflux (GOR) (n = 6). The second group (n = 11) had recurrent GOR and the third group (n = 4) complained of a sense of excessive fullness. RESULTS: In the dysphagia group the reason for it in 4 patients was severe fibrosis in the hiatal region including the right part of the fundoplication. One patient had correctly located fundoplication but it was too tight. In the last patient the part of the stomach used was too low down. All patients in the GOR group had a slippage and rupture of the fundoplication. Ten patients also had a recurrent hernia. In 6/11 patients the fundal mobilisation was incomplete. In the last group (excessive fullness) one patient had a postoperative leak from the fundal part, one patient a para-oesophageal hernia, and one patient an intact but herniated repair. One further patient had an intact abdominal oesophagus and crural repair, but a large portion of the stomach had herniated through the left part of the fundoplication and acted as a volvulus. CONCLUSIONS: Dysphagia was caused by hiatal fibrosis or other technical failures rather than a normal tight fundoplication. Using the wrong part of the stomach causes recurrent heartburn. The laparoscopic suturing technique must be improved.

Adult↗
PubMed2004

Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux.

With wide application of antireflux surgery, reoperations for failed fundoplications are increasingly seen. This study was undertaken to document outcomes after reoperative fundoplications. Sixty-four patients, 26 men and 38 women, of average age 55 years+/-15.6 (SD), underwent reoperative antireflux surgery between 1992 and 2003. Fundoplication prior to reoperation had been undertaken via celiotomy in 27 and laparoscopically in 37. Both before and after reoperative antireflux surgery, patients scored their reflux and dysphagia on a Likert Scale (0 = none, 10 = continuous). Reoperation was undertaken because of dysphagia in 16 per cent, recurrent reflux in 52 per cent (median DeMeester Score 52), or both in 27 per cent. Failure leading to reoperation was due to hiatal failure in 28 per cent, wrap failure in 19 per cent, both in 33 per cent, and slipped Nissen fundoplication in 20 per cent. Laparoscopic reoperations were completed in 49 of 54 patients (91%); 15 had reoperations undertaken via celiotomy. Eighty-eight per cent of reoperations were Nissen fundoplications. With reoperation, Dysphagia Scores improved from 9.5+/-0.7 to 2.6+/-2.8, and Reflux Scores improved from 9.1+/-1.4 to 1.8+/-2.7. Seventy-nine per cent of patients with reflux prior to reoperation, 100 per cent with dysphagia, and 74 per cent with both noted excellent or good outcomes after reoperation. We conclude that failure after fundoplication occurs. Reoperations reduce the severity of dysphagia and reflux, thus salvaging excellent and good outcomes in most. Laparoscopic reoperations are generally possible. Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux, and their application is encouraged.

Adult↗
PubMed2006

Laparoscopic Nissen fundoplication offers high patient satisfaction with relief of extraesophageal symptoms of gastroesophageal reflux disease.

Nissen fundoplication is applied for patients with gastroesophageal reflux disease (GERD), usually because of symptoms of esophageal injury. When presenting symptoms are extraesophageal, there is less enthusiasm for operative control of reflux because of concerns of etiology and efficacy. This study was undertaken to evaluate the efficacy of laparoscopic Nissen fundoplication in palliating extraesophageal symptoms of GERD. Patients were asked to score their symptoms before and after laparoscopic Nissen fundoplication on a Likert scale (0 = never/none to 5 = always/every time I eat). A total of 322 patients with extraesophageal symptoms (asthma, cough, gas/bloat, chest pain, and odynophagia) of 4 to 5 were identified and analyzed. After fundoplication, all extraesophageal symptom scores improved (P < 0.0001 for all, Wilcoxon matched-pairs test). Likewise, postoperative symptoms were noted to be greatly improved or resolved in 67 per cent to 82 per cent of patients for each symptom. Furthermore, after fundoplication, patients were less likely to modify their dietary (82% vs 49%) or sleeping habits (70% vs 28%) to avoid initiating/ exacerbating symptoms. Although extraesophageal symptoms are conventionally thought to be inadequately palliated by surgery, this study documents excellent relief of extraesophageal symptoms after laparoscopic Nissen fundoplication, denotes high patient satisfaction, and encourages application of laparoscopic Nissen fundoplication.

Asthma↗
PubMed1997

Effect of fundoplication on transient lower oesophageal sphincter relaxation and gas reflux.

BACKGROUND: Fundoplication is used widely to treat severe gastro-oesophageal reflux disease. Difficulty in belching and increased flatulence are common side-effects. Transient lower oesophageal sphincter (LOS) relaxation is important to help vent gas from the stomach. The effect of fundoplication on LOS function and gas reflux was therefore investigated. METHODS: Oesophageal manometry was performed before operation and 3-15 months after fundoplication in 14 patients with reflux disease who had a total (360 degrees) fundoplication. Five patients also had highly selective vagotomy. Gastric distension was induced by 750 ml carbon dioxide. RESULTS: Fundoplication reduced the median number of episodes of gas reflux during 10 min of gastric distension from 5 (interquartile range (i.q.r.) 3-7) to 0 (i.q.r. 0), and the median number of transient LOS relaxations from 4 (i.q.r. 2-6) to 0 (i.q.r. 0-1). Fundoplication did not affect basal LOS pressure but significantly increased nadir pressure during swallow-induced relaxation. CONCLUSION: Fundoplication controls reflux by inhibiting the triggering of transient LOS relaxation and by preventing the complete ablation of pressure at the gastro-oesophageal junction during LOS relaxation. These effects may also contribute to the side-effects of the operation.

Adult↗
PubMed1998

Quality of life and antireflux medication use following laparoscopic Nissen fundoplication.

With the advent of minimally invasive techniques, the surgical treatment of gastroesophageal reflux disease has received renewed interest. The efficacy of laparoscopic Nissen fundoplication in eliminating reflux has been documented. This study was undertaken to determine changes in quality of life and cost of antireflux medications after laparoscopic Nissen fundoplication. One hundred patients undergoing laparoscopic Nissen fundoplication between 1992 and 1997 completed questionnaires assessing changes in pre- and postoperative cost and number of antireflux medications, reflux symptoms, and quality of life. The average number of antireflux medications was significantly reduced (1.8 versus 0.3, P < 0.0001) as was the average monthly cost ($170 versus $30, P < 0.0001). Patients reported significant (P < 0.05) symptomatic improvement in postprandial heartburn, nocturnal heartburn, postprandial nausea, postprandial vomiting, dysphagia, and gas/bloating. Patients in this series noted fewer symptoms and used fewer antireflux medications at less cost after laparoscopic Nissen fundoplication. Symptoms commonly thought of as complications of fundoplication (vomiting, dysphagia, gas/bloating) were less common after fundoplication. This report documents the efficacy of laparoscopic fundoplication in improving quality of life and reducing use and cost of antireflux medications.

Adolescent↗
PubMed1993

Prospective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastro-oesophageal reflux disease.

Teres cardiopexy was compared with Nissen fundoplication in a prospective randomized study of surgery for gastro-oesophageal reflux disease refractory to medical treatment. Follow-up at 3 months of ten patients undergoing each procedure showed good clinical results and improvement of the mean symptom score in both groups, for cardiopexy from 7.8 to 1.1 (P < 0.01) and for fundoplication from 5.7 to 0.2 (P < 0.01). After 1 year, six of the ten patients undergoing cardiopexy required a second antireflux procedure because of recurrent disease, whereas one reoperation was performed after fundoplication. The mean symptom score after 1 year was higher in patients submitted to cardiopexy than in those receiving fundoplication (3.9 versus 0.3, P < 0.01). The mean endoscopic oesophagitis score after 1 year was no different from preoperative values after cardiopexy (1.9 versus 1.9) but was significantly lower after fundoplication (1.5 versus 0.3, P = 0.01). Ambulatory 24-h pH monitoring showed a significantly higher proportion of total time at pH < 4 after cardiopexy than fundoplication (24.0 versus 3.8 per cent, P < 0.05). Cardiopexy is significantly less effective than fundoplication for the treatment of gastro-oesophageal reflux disease assessed at 1-year follow-up. This study does not support the use of cardiopexy either in conventional or laparoscopic antireflux surgery.

Adult↗
PubMed1980

Long-term effect of Nissen fundoplication in young puppies.

Nissen fundoplication effectively prevents gastroesophageal reflux in children. However, the long-term effect of this operation on the distal esophagus of infants and children is unknown, and a fear has been expressed that wrap-around operations on a small infant esophagus would constrict growth of the lower esophagus and cause late partial obstruction. In this study, the long-term effect of Nissen fundoplication was evaluated. There were 20, 1-2-wk-old puppies operated upon; 10 underwent Nissen fundoplication and 10 had only a sham operation to serve as a control group. Three puppies in each group had esophageal manometry and barium studies of the esophagus preoperatively and at various times postoperatively. The diameter of the esophagus was measured in all dogs during the operation. All fundoplications were done with a #20F dilator inside the esophagus. Two dogs in each group were sacrificed at 1, 2, and 3 yr of age, and the remainder were sacrificed at 4 yr of age. At autopsy, there was no difference in the diameter of the esophagus in the dogs with Nissen fundoplication compared with the sham-operated dogs. Barium studies in the fundoplicated group showed no dilation of the esophagus compared to the sham-operated group. Both groups grew normally and there were no differences in weight at the time of sacrifice. It seems that Nissen fundoplication does not affect growth of the distal esophagus in young puppies, and that body weight and linear growth are not altered by this operation.

Animals↗
PubMed1991

Intestinal motility in symptomatic children with fundoplication.

Fundoplication alters the anatomy of the lower esophageal sphincter but should have no direct effects on motility distal to the sphincter. Of 55 children referred for evaluation of symptoms consistent with upper gastrointestinal motor dysfunction, 28 had undergone fundoplication 6 months to 4 years earlier to treat severe gastroesophageal reflux that had failed medical management. All 28 children had symptoms that were unchanged or worsened after fundoplication. In all children, we studied fasting and fed antroduodenal motility, and compared results from groups with and without fundoplication. Abnormalities in antroduodenal motility were found in 25 of 28 of the fundoplication group and in 25 of 27 of unoperated children. We found a wide range of abnormalities, but there were no differences in the types of severity of abnormalities between groups. In summary, in children with severe functional gastrointestinal symptoms, antroduodenal manometry uncovered physiological abnormalities, and fundoplication failed to relieve symptoms. These data suggest that preoperative intestinal manometry could identify children unlikely to benefit from fundoplication.

Adolescent↗
PubMed1985

The effect of fundoplication with or without proximal gastric vagotomy on gastric emptying and serum gastrin.

Jordan and Herrington have both advocated the addition of a proximal gastric vagotomy [PGV] to fundoplication to improve exposure and decrease the likelihood of vagal entrapment which might lead to delayed gastric emptying. This study documents the effect of fundoplication with or without PGV on gastric emptying and postprandial gastrin values. Twelve dogs had measurement of gastric emptying of an isotopically labeled solid meal. Plasma gastrin was also measured at 15-min intervals for 1 hr postprandially following a 60 g beef meal. Six of the animals then had a standard fundoplication with incorporation of vagi in the wrap; the other six underwent fundoplication combined with PGV, excluding the vagi. All studies were repeated after 8 weeks. Gastric emptying was unchanged by fundoplication alone. PGV resulted in a slight but significant slowing of gastric emptying (P = 0.04), values by paired t test. Fundoplication alone had no effect on serum gastrin levels, but there was a slight, statistically insignificant increase in serum gastrin when PGV was added (P greater than 0.1). This delay could aggravate pre-existing emptying problems in patients with esophagitis. These data do not support inclusion of proximal gastric vagotomy as a routine part of the fundoplication.

Animals↗
PubMed1994

Laparoscopic fundoplication for gastro-oesophageal reflux.

The initial teaching and learning experience of four surgeons performing a laparoscopic Nissen fundoplication is reported. A total of 33 patients underwent the laparoscopic approach for Nissen fundoplication. Two patients also underwent concomitant cholecystectomy. A loose 360 degrees fundoplication secured by three or four sutures was performed, with 29 patients also undergoing posterior crural repair. Three operations were converted to open procedures. Two patients required subsequent surgery, one when the fundoplication and proximal stomach slipped into the chest and one for oesophageal obstruction. No other complications occurred. All patients are well and free of reflux symptoms at follow-up ranging up to 10 months (median 5 months). Operating time ranged from 47 min to 154 min (median 81 min) for fundoplication alone. The laparoscopic fundoplications with cholecystectomy required 145 and 170 min. Postoperative stay ranged from 3 to 12 days (median 3 days). Laparoscopic Nissen fundoplication is feasible in the management of gastro-oesophageal reflux disease. These early results demonstrate that this new technique may reduce some of the morbidity associated with open antireflux surgery. A prospective randomised study has been started to assess efficacy and benefits more thoroughly.

Adult↗
PubMed1999

Functional outcome after laparoscopic or open Nissen fundoplication: a follow-up study.

OBJECTIVE: To compare the results of open and laparoscopic fundoplication. DESIGN: Nonrandomized controlled study with a 3-year follow-up. PATIENTS AND METHODS: Fifty-seven consecutive patients with erosive reflux esophagitis underwent laparoscopic (30 patients) or open (27 patients) fundoplication. INTERVENTIONS: Interview by an independent person. In addition, 52 patients (91%) underwent postoperative endoscopy, and 38 patients (67%) underwent esophageal 24-hour pH recording. RESULTS: Temporary dysphagia was reported by 20 patients (67%) after laparoscopic and by 11 (41%) after open fundoplication (P = .05). There were no differences between groups concerning incidence of persistent dysphagia (20% vs 18%, respectively) and mild to no reflux symptoms (97% vs 100%, respectively). In addition, bloating (50% vs 63%, respectively) and increased flatus (77% vs 78%, respectively) were equally common. Visual analog scale scores for dysphagia, bloating, and increased flatus were 0.6, 2.4, and 4.3, respectively, in the laparoscopic and 0.6, 3.5, and 3.4, respectively, in the open groups. Normal belching ability was reported by 12 patients (40%) after laparoscopic and by 20 (74%) after open fundoplication (P = .01). Visick grade 1 or 2 was reported by 21 patients (70%) after laparoscopic and by 24 (89%) after open fundoplication (P = .08). Defective fundic wrap was detected in 4 patients (13%) in the laparoscopic and in none in the open group. In addition, abnormal results of 24-hour pH recording were found in 4 patients (22%) after laparoscopic and in 2 (10.5%) after open fundoplication. CONCLUSION: From a functional point of view, both techniques were equally effective except concerning belching ability and temporary dysphagia.

Adult↗
PubMed2000

Effect of an esophageal bougie on the incidence of dysphagia following nissen fundoplication: a prospective, blinded, randomized clinical trial.

HYPOTHESIS: Based on retrospective, uncontrolled studies, it has been claimed that Nissen fundoplication should be performed over an esophageal bougie to minimize postoperative dysphagia. We hypothesized that a surgeon experienced in laparoscopic fundoplication will have similar rates of postoperative dysphagia whether or not an esophageal bougie is used. DESIGN: A patient and observer blinded, randomized, prospective clinical trial to assess the effect of intraoperative bougie use. SETTING: A tertiary care teaching hospital that is a regional referral source for complex laparoscopic foregut surgical procedures. PATIENTS: Three hundred thirty-six consecutive patients referred for laparoscopic fundoplication between March 1, 1996, and July 31, 1998, were evaluated for eligibility based on inclusion criteria and, if applicable, were offered randomization for fundoplication with or without a 56F bougie. One hundred seventy-one patients were enrolled in this study. INTERVENTIONS: All patients underwent laparoscopic Nissen fundoplication, 81 with a bougie (hereafter referred to as the bougie group) and 90 without a bougie (hereafter referred to as the no bougie group). MAIN OUTCOME MEASURES: Dysphagia severity and frequency were assessed by a blinded observer using a standardized scoring system. Incidence of complications related to the use or absence of a bougie, operative times, and postsurgical recovery was also assessed. RESULTS: The mean operating time was 148 minutes (range, 65-295 minutes). The overall operative morbidity was 9% (7. 4% in the bougie group and 11% in the no bougie group, P=.41). One esophageal injury (1.2%) occurred in the bougie group. The 30-day mortality was 0. Long-term dysphagia assessment was completed in 90% of patients, with a mean follow-up of 11 months. Overall, long-term postoperative dysphagia was present in 13 patients (17%) in the bougie group and 24 patients(31%) in the no bougie group (P=.047). Severe dysphagia occurred in 5% of patients in the bougie group and 14% in the no bougie group. CONCLUSION: This study confirms the dogma that use of a large-caliber stent during the creation of a fundoplication decreases the long-term incidence of dysphagia; albeit at the risk of injury from the introduction of a bougie.

Adult↗
PubMed2002

Outcomes of laparoscopic Nissen fundoplication in patients with the "hypercontractile esophagus".

HYPOTHESIS: To determine if a hypercontractile esophagus, manifested by high-amplitude peristaltic contractions (HAPCs) or hypertensive lower esophageal sphincter (HLES), affects the outcome of antireflux surgery. DESIGN: Case series. Prospectively maintained database. Direct contact with patients. Mean follow-up 28.7 months. SETTING: University hospital. PATIENTS: Of 643 patients who had antireflux surgery for uncomplicated gastroesophageal reflux disease (GERD), 15 had HAPCs (> or = 150 mm Hg) and 4 HLES (> or = 45 mm Hg). INTERVENTION: Laparoscopic Nissen fundoplication in all patients. MAIN OUTCOME MEASURES: (1) Frequency of hypercontractile esophagus in patients considered for antireflux procedure. (2) Effect of fundoplication on esophageal acid exposure and symptoms. (3) Establish whether dysphagia or chest pain develop after fundoplication. RESULTS: The typical GERD symptoms of heartburn and/or regurgitation occurred in 15 (79%) and 13 (69%) of 19 patients. Dysphagia was present in 5 of 15 patients with HAPCs and in 0 of 4 with HLES; chest pain was found 5 of 15 patients with HAPCs. After fundoplication acid exposure was improved in all (92%, 16/17) but 1 and was totally normal in 10 patients (83%). Heartburn improved in 11(78%) of 14 and resolved in 8 patients (57%) of the 14. Chest pain improved in 4 (80%) of the 5 patients who had it, and developed in 3 (23%) who did not have it preoperatively. In patients with HAPCs, dysphagia improved in 4 (80%) of 5 patients with complete resolution in 3 (60%). New dysphagia developed in 2 (11%) of the 19 patients, 1 in each group. No patient with HLES developed chest pain. CONCLUSIONS: High-amplitude peristaltic contractions or HLES may be associated with GERD in a subset of patients with dysphagia or chest pain. In such patients, a Nissen fundoplication, by effectively controlling GERD, relieves these symptoms in most patients. A hypercontractile esophagus in patients with GERD should not be considered a contraindication to a total fundoplication. The surgeon and the patient should be aware of the risk of developing chest pain after the operation.

Adolescent↗
PubMed2005

Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study.

BACKGROUND: Postoperative intrathoracic wrap migration is the most frequent morphological complication after laparoscopic antireflux surgery. Previous authors have studied the use of prosthetic materials for hiatal closure to prevent recurrence of hiatal hernia and/or postoperative intrathoracic wrap herniation. HYPOTHESIS: Patients with prosthetic hiatal closure have a higher rate of short-term dysphagia but a significantly lower rate of postoperative intrathoracic wrap herniation at follow-up. DESIGN: Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatoplasty with those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure. SETTING: University-affiliated community hospital. PATIENTS: One hundred consecutive patients undergoing laparoscopic Nissen fundoplication for gastroesophageal reflux disease and hiatal hernia repair. INTERVENTION: Laparoscopic Nissen fundoplication with simple sutured crural closure (n = 50 [group 1]) vs laparoscopic Nissen fundoplication with simple sutured cruroplasty and onlay of a polypropylene mesh (n = 50 [group 2]). MAIN OUTCOME MEASURES: Recurrences; complications; results of esophageal manometry, 24-hour pH monitoring, esophagogastroduodenoscopy, and barium swallow test; and symptomatic outcome. RESULTS: Patients in both groups had similar preoperative values in esophageal manometry, 24-hour pH monitoring, and symptom scoring. At the 3-month and 1-year follow-ups, functional outcome variables (lower esophageal sphincter pressure and DeMeester score) improved significantly compared with the preoperative values. A higher postoperative dysphagia rate could be evaluated in group 2. An intrathoracic wrap migration occurred in 13 patients (26%) in group 1 vs 4 (8%) in group 2 (P<.001). CONCLUSION: Laparoscopic Nissen fundoplication with prosthetic cruroplasty is an effective procedure to reduce the incidence of postoperative hiatal hernia recurrence and intrathoracic wrap herniation.

Female↗
PubMed2006

Impact of laparoscopic nissen fundoplication with prosthetic hiatal closure on esophageal body motility: Results of a prospective randomized trial.

HYPOTHESIS: Prosthetic crural closure does not adversely influence esophageal body motility. In most patients, postoperative increased dysphagia resolves spontaneously during the first months after surgery. DESIGN: Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatal closure and those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure. SETTING: University-affiliated community hospital. PATIENTS: Forty consecutive patients who underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease. INTERVENTIONS: A 360 degrees Nissen fundoplication with simple sutured crura (n = 20; nonmesh group) vs the same procedure with posterior 1 x 3-cm polypropylene onlay mesh prosthesis (n = 20; mesh group). MAIN OUTCOME MEASURES: Recurrences; postoperative dysphagia rate; localization, length, and pressure of the lower esophageal sphincter (LES); results of 24-hour pH monitoring; esophageal body motility; peristalsis; and esophageal amplitude of contraction and interrupted waves. RESULTS: Preoperatively, both groups had pathological LES pressure and DeMeester scores. These values improved significantly (P < .01) after surgery and remained stable at 1 year after surgery. Patients in the nonmesh group had a significantly lower LES pressure 1 year after surgery compared with those in the mesh group. There were no significant differences in postoperative mean LES length (4.1 vs 3.8 cm), LES relaxation (93.4% vs 92.4%), and intra-abdominal LES length (2.1 vs 2.1 cm). Patients in the mesh group had fewer simultaneous waves and interrupted waves 1 year after surgery, but the difference between groups was not significant. There were no significant differences in interrupted waves and amplitude of contraction between groups 1 year after surgery. CONCLUSION: Laparoscopic Nissen fundoplication with prosthetic crural closure does not impair postoperative esophageal body motility compared with laparoscopic Nissen fundoplication with simple suture hiatal closure, although it is associated with a higher rate of short-term dysphagia.

Adult↗
PubMed2002

Needlescopic fundoplication.

BACKGROUND: Minimally invasive surgery continues to evolve, with an emphasis on developing new techniques and applying new technology to surgical procedures. The purpose of this study was to compare the short-term outcomes of needlescopic fundoplication with those of conventional laparoscopic fundoplication. METHODS: Between January 1999 and June 2000, 38 needlescopic fundoplications were performed, and the short-term outcomes for these patients were compared with those for a contemporary matched cohort of patients who had undergone a conventional laparoscopic fundoplication. RESULTS: There was a nonsignificant trend toward decreased operative time (143.4 to 127 min; p = 0.13), blood loss (54.3 to 48 ml; p = 0.30), narcotic requirements (29.5 to 19.5 morphine equivalents; p = 0.32), and length of hospital stay (1.78 to 1.49 days; p = 0.10) in the needlescopic group. There were no significant differences in intraoperative complications (2.6% vs 2.6%; p = 1.0). Two needlescopic cases were converted to laparoscopic cases because of obesity. Postoperatively, there were no significant differences in rates of early dysphagia (7.9% vs 7.9%), bloating (13.2% vs 5.3%; p = 0.43), or other complications (5.3% vs 5.3%) between the groups. There was a significant reduction in mean operative time for needlescopic fundoplication after the first four cases (166 +/- 44 vs 120 +/- 32 min; p = 0.03). CONCLUSIONS: Needlescopic fundoplication poses no disadvantage, and it offers the added cosmetic benefit of smaller incisions.

Adolescent↗
PubMed2006

Five-year results of laparoscopic Toupet fundoplication as the primary surgical repair in GERD patients: is it durable?

INTRODUCTION: Most surgeons operate on gastroesophageal reflux disease (GERD) patients using the concept of "tailored approach," which depends on esophageal motility. We have abandoned this concept and performed laparoscopic Toupet fundoplication in all patients suffering from GERD, independent of their esophageal motility. METHODS: In a prospective trial we have assessed and evaluated our 5-year results of the first 100 consecutive patients treated with laparoscopic Toupet fundoplication. All patients were evaluated preoperatively by endoscopy and 24-h pH manometry. The patients were followed up clinically 1, 2, 6, 12 and 60 months postoperatively. The course of clinical DeMeester score, appearance and treatment of wrap-related side-effects as well as long-term outcome and patient satisfaction were evaluated. RESULTS: The 5-year follow-up rate was 87%. Laparoscopic Toupet fundoplication achieved a 5-year healing rate of GERD in 85%. Of all operated patients, 3.5% had to be reinstalled on a regular PPI treatment because of postoperative GERD reappearance. The median clinical DeMeester score decreased from 4.27 +/- 1.5 points preoperatively to 0.47 +/- 0.9 points 5 years postoperatively (p < 0.0005). Because of persistent postoperative dysphagia, 5% of the patients required endoscopic dilatation therapy. Persistent postoperative gas-bloat syndrome occurred in 1.1%. Wrap dislocation was identified in 3.4% of patients. Reoperation rate was 5%. Total morbidity rate was 19.5% and operative related mortality rate was 0%. Overall, 96.6% of patients were pleased with their outcome at late follow-up, and 95.4% of patients stated they would consider undergoing laparoscopic fundoplication again if necessary. CONCLUSION: Our long-term results showing a low recurrence and morbidity rate of laparoscopic Toupet fundoplication encourage us to continue to perform this procedure as the primary surgical repair in all GERD patients, independent of their esophageal motility. Laparoscopic Toupet fundoplication has proven to be a safe and successful therapeutic option in GERD patients.

Adult↗