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Erschienen in: Surgical Endoscopy 1/2021

03.02.2020

Laparoscopic fundoplication for refractory GERD: a procedure worth repeating if needed

verfasst von: Zia Kanani, Jon C. Gould

Erschienen in: Surgical Endoscopy | Ausgabe 1/2021

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Abstract

Background

Laparoscopic fundoplication is the current gold standard for medically refractory gastroesophageal reflux disease. Over a 10-year period following surgery, 5–10% of primary laparoscopic fundoplication patients undergo reoperative surgery. Our objective was to compare the symptomatic outcomes and morbidity of primary and reoperative fundoplication procedures.

Methods

This was a retrospective review of patients who underwent laparoscopic primary or reoperative fundoplication between 2011 and 2017. A single surgeon with a more than 10-year experience in reoperative foregut surgery performed all procedures. Patients in both groups completed the GERD health-related quality of life (GERD-HRQL) survey prior to surgery and postoperatively. Outcomes were reflected by the composite GERD-HRQL scores (0 to 50, with lower scores representing a better GERD-related quality of life), which were compared between groups postoperatively. Demographics, perioperative data, and complications were compared. Patient data were analyzed using Chi-Square tests and outcomes were analyzed using independent samples t tests and Mann–Whitney U tests.

Results

There were 136 primary and 82 reoperative fundoplications. Prior to surgery, GERD-HRQL scores were similar for primary and reoperative patients. Both groups experienced significant improvement in GERD-related quality of life at 2 years, although this improvement was greater in primary patients (8.7 ± 7.8 primary vs. 14.3 ± 13.6 reoperative, p = 0.02). Operative time and length of stay were longer following reoperative cases. The rate of moderate to severe 30-day complications requiring radiologic, endoscopic, or surgical intervention was similar (2.9% primary vs. 1.2% reoperative, p = 0.65).

Conclusions

Patients who undergo reoperative fundoplication experience a significant improvement in their GERD-related symptoms, although not to the degree seen in primary antireflux surgery patients. Perioperative morbidity rates following reoperative and primary procedures can be similar in the hands of an experienced surgeon.
Literatur
1.
Zurück zum Zitat El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880 CrossRef El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880 CrossRef
2.
Zurück zum Zitat Grant A, Boachie C, Cotton S, Faria R, Bojke L, Epstein DM, Ramsay CR, Corbacho B, Sculpher M, Krukowski ZH, Heading RC, Campbell MK (2013) Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease: 5-year follow-up of multicentre randomised trial (the REFLUX trial). Health Technol Assess 17:1–167 CrossRef Grant A, Boachie C, Cotton S, Faria R, Bojke L, Epstein DM, Ramsay CR, Corbacho B, Sculpher M, Krukowski ZH, Heading RC, Campbell MK (2013) Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease: 5-year follow-up of multicentre randomised trial (the REFLUX trial). Health Technol Assess 17:1–167 CrossRef
4.
Zurück zum Zitat Teixeira JR, Moreira LM, Flores A, Ribeiro C (2012) Durability of long-term results of laparoscopic nissen—comparison of the results at 5 years and 10 years after surgery. Hepatogastroenterology 59:2428–2431 PubMed Teixeira JR, Moreira LM, Flores A, Ribeiro C (2012) Durability of long-term results of laparoscopic nissen—comparison of the results at 5 years and 10 years after surgery. Hepatogastroenterology 59:2428–2431 PubMed
5.
Zurück zum Zitat Fein M, Bueter M, Thalheimer A, Pachmayr V, Heimbucher J, Freys SM, Fuchs KH (2008) Ten-year outcome of laparoscopic antireflux surgery. J Gastrointest Surg 12:1893–1899 CrossRef Fein M, Bueter M, Thalheimer A, Pachmayr V, Heimbucher J, Freys SM, Fuchs KH (2008) Ten-year outcome of laparoscopic antireflux surgery. J Gastrointest Surg 12:1893–1899 CrossRef
6.
Zurück zum Zitat Zhou T, Harnsberger C, Broderick R, Fuchs H, Talamini M, Jacobsen G, Horgan S, Chang D, Sandler B (2015) Reoperation rates after laparoscopic fundoplication. Surg Endosc 29:510–514 CrossRef Zhou T, Harnsberger C, Broderick R, Fuchs H, Talamini M, Jacobsen G, Horgan S, Chang D, Sandler B (2015) Reoperation rates after laparoscopic fundoplication. Surg Endosc 29:510–514 CrossRef
7.
Zurück zum Zitat Wilshire CL, Louie BE, Schultz D, Jutric Z, Farivar AS, Aye RS (2016) Clinical outcomes of reoperation for failed antireflux operations. Ann Thorac Surg 101:1290–1296 CrossRef Wilshire CL, Louie BE, Schultz D, Jutric Z, Farivar AS, Aye RS (2016) Clinical outcomes of reoperation for failed antireflux operations. Ann Thorac Surg 101:1290–1296 CrossRef
8.
Zurück zum Zitat Musunuru S, Gould J (2012) Perioperative outcomes of surgical procedures for symptomatic fundoplication failure: a retrospective case-control study. Surg Endosc 26:838–842 CrossRef Musunuru S, Gould J (2012) Perioperative outcomes of surgical procedures for symptomatic fundoplication failure: a retrospective case-control study. Surg Endosc 26:838–842 CrossRef
9.
Zurück zum Zitat Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications. Ann Surg 240:205–213 CrossRef Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications. Ann Surg 240:205–213 CrossRef
10.
Zurück zum Zitat Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esoph 20:130–134 CrossRef Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esoph 20:130–134 CrossRef
14.
Zurück zum Zitat Van Beek DB, Auyang ED, Soper NJ (2011) A comprehensive review of laparoscopic redo fundoplication. Surg Endosc 25:706–712 CrossRef Van Beek DB, Auyang ED, Soper NJ (2011) A comprehensive review of laparoscopic redo fundoplication. Surg Endosc 25:706–712 CrossRef
Metadaten
Titel
Laparoscopic fundoplication for refractory GERD: a procedure worth repeating if needed
verfasst von
Zia Kanani
Jon C. Gould
Publikationsdatum
03.02.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 1/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07396-9

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