Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease.
Ronald A. Hinder,Charles J. Filipi,Gerold J. Wetscher,Patricia Neary,Tom R. DeMeester,Galen Perdikis +5 more
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TL;DR: The laparoscopic Nissen fundoplication can be carried out safely and effectively with similar positive results to the open procedure and with all of the advantages of the minimally invasive approach.
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Abstract: OBJECTIVE: The open Nissen fundoplication is effective therapy for gastroesophageal reflux disease. In this study, the outcomes in 198 patients treated with the laparoscopic Nissen fundoplication was evaluated for up to 32 months after surgery to ascertain whether similar positive results could be obtained. SUMMARY BACKGROUND DATA: To ensure surgical success, patients were required to have mechanically defective sphincters on manometry and increased esophageal acid exposure on 24-hour pH monitoring. The patients either had severe complications of gastroesophageal reflux disease or had failed medical therapy. These requirements have been found to be necessary to ensure a successful surgical outcome. METHODS: The disease was complicated by ulceration (46), stricture (25) and Barrett's esophagus (33). Patients underwent standard Nissen fundoplications identical in every detail to open procedures except that the procedures were carried out by the laparoscopic route. RESULTS: Perioperative complications included gastric or esophageal perforation (3), pneumothorax (2), bleeding (2), breakdown of crural repair (2) and periesophageal abscess (1). The only mortality occurred from a duodenal perforation. Six patients required conversion to the open procedure. The median hospital stay was 3 days. One hundred patients were observed for follow-up for 6 to 32 months (median 12 months), with outcomes similar to the open Nissen fundoplication. Further surgery was required for two patients who had recurrent gastroesophageal reflux and one who developed an esophageal stricture. Ninety-seven percent are satisfied with their decision to have the operation. CONCLUSIONS: The laparoscopic Nissen fundoplication can be carried out safely and effectively with similar positive results to the open procedure and with all of the advantages of the minimally invasive approach.
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Citations
Clinical esophageal pH recording: A technical review for practice guideline development
TL;DR: The present concept of peptic esophagitis dates back to 1935, when Winkelstein suggested that gastric secretions were the cause of mucosal damage observed in peptic eosinophitis.
519
A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease.
TL;DR: The most frequent indication for surgery was the presence of residual typical and atypical gastroesophageal reflux symptoms (64%) despite standard doses of proton pump inhibitors.
470
The development of the GERD-HRQL symptom severity instrument.
TL;DR: The GERD-HRQL was initially developed to measure the typical symptoms of GERD and was initially determined to have face validity and subsequent studies assessed its content validity, criterion validity, concurrent validity, predictive validity and construct validity.
463
Guidelines for surgical treatment of gastroesophageal reflux disease
Dimitrios Stefanidis,William W. Hope,Geoffrey P. Kohn,Patrick R. Reardon,William S. Richardson,Robert D. Fanelli +5 more
TL;DR: GERD was defined according to the Montreal Consensus as “a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications” and was considered “troublesome” if they adversely affected an individual’s well-being.
448
Multivariate analysis of factors predicting outcome after laparoscopic Nissen fundoplication.
Guilherme M. Campos,Jeffrey H. Peters,Tom R. DeMeester,Stefan Öberg,Peter F. Crookes,Silvia Tan,Steven R. DeMeester,Jeffrey A. Hagen,Cedric G. Bremner +8 more
TL;DR: 24-hour pH monitoring provides the strongest outcome predictor of laparoscopic Nissen fundoplication and that outcome is based more on the correct identification of the disease than on its severity.
366
References
Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients.
TL;DR: It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.
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Healing and relapse of severe peptic esophagitis after treatment with omeprazole
David J. Hetzel,David J. Hetzel,David J. Hetzel,John Dent,John Dent,John Dent,William D. Reed,William D. Reed,William D. Reed,Firoze M. Narielvala,Firoze M. Narielvala,Firoze M. Narielvala,M. Mackinnon,M. Mackinnon,M. Mackinnon,Justin H. McCarthy,Justin H. McCarthy,Justin H. McCarthy,Brent Mitchell,Brent Mitchell,Brent Mitchell,Bruce R. Beveridge,Bruce R. Beveridge,Bruce R. Beveridge,Bernard H. Laurence,Bernard H. Laurence,Bernard H. Laurence,Geoffrey G. Gibson,Geoffrey G. Gibson,Geoffrey G. Gibson,Alan Kerr Grant,Alan Kerr Grant,Alan Kerr Grant,David J.C. Shearman,David J.C. Shearman,David J.C. Shearman,Richard Whitehead,Richard Whitehead,Richard Whitehead,Peter J. Buckle,Peter J. Buckle,Peter J. Buckle +41 more
TL;DR: Omeprazole is a highly effective treatment for peptic esophagitis, and the 40-mg/day dosage produces endoscopic healing slightly more quickly than the 20-mg/, and the initial endoscopic gradings are of prognostic value.
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