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Erschienen in: Surgical Endoscopy 3/2020

18.06.2019 | 2019 SAGES Oral

The relationship between gastroesophageal junction integrity and symptomatic fundoplication outcomes

verfasst von: Brexton Turner, Melissa Helm, Emily Hetzel, Max Schumm, Jon C. Gould

Erschienen in: Surgical Endoscopy | Ausgabe 3/2020

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Abstract

Background

The majority of patients who undergo a laparoscopic fundoplication for gastroesophageal reflux disease (GERD) have a structural (hiatal hernia, shortened lower esophageal sphincter [LES]) or functional (weak LES) defect of the gastroesophageal junction (GEJ). We hypothesized that the symptomatic outcomes of fundoplication in patients with a competent GEJ prior to surgery are inferior to those with an incompetent GEJ.

Methods

This is a retrospective review of prospectively maintained data on subjects who underwent primary laparoscopic fundoplication (Nissen or Toupet) for medically refractory and confirmed GERD. Three esophageal manometry variables were used to determine GEJ competency: (1) hiatal hernia (normal = no hernia), (2) total lower esophageal sphincter length (normal ≥ 2.43 cm), and (3) lower esophageal sphincter pressure (normal = 15.0–43.7 mmHg). Patients in the competent group had normal values for all 3 variables. Symptomatic outcomes were assessed with the GERD Health-Related Quality of Life (HRQL) survey administered pre- and postoperatively, and then compared both intragroup, intergroup, and by procedure.

Results

A total of 78 patients met inclusion criteria—17 competent GEJ and 61 incompetent GEJ patients. GERD-HRQL scores improved in the incompetent cohort at all intervals out to 2 years postoperatively. GERD-HRQL improved in the competent cohort at 2 months, with no difference at 6 months or 2 years postoperatively compared to preoperative scores. Competent GEJ patients receiving a Nissen fundoplication had a higher rate of additional procedures (endoscopy with or without dilation, pH studies) following surgery to address recurrent or persistent GERD symptoms compared to Toupet.

Conclusions

GERD patients with a competent GEJ report a lower GERD-HRQL with more frequent and severe reflux symptoms up to 2 years post-fundoplication. Competent GEJ patients receiving a Nissen fundoplication are more likely to have additional procedures to address symptoms following surgery. Surgeons should approach patients with a competent GEJ and medically refractory GERD with caution.
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Metadaten
Titel
The relationship between gastroesophageal junction integrity and symptomatic fundoplication outcomes
verfasst von
Brexton Turner
Melissa Helm
Emily Hetzel
Max Schumm
Jon C. Gould
Publikationsdatum
18.06.2019
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2020
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06921-9

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