Universität zu Köln

Fuchs, K. H., Breithaupt, W., Varga, G., Babic, B., Schulz, T. and Meining, A. (2022). Primary laparoscopic fundoplication in selected patients with gastroesophageal reflux disease. Dis. Esophagus, 35 (1). CARY: OXFORD UNIV PRESS INC. ISSN 1442-2050

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Abstract

Background: Despite proton pump inhibitors being a powerful therapeutic tool, laparoscopic fundoplication (LF) has proven successful in the treatment of gastroesophageal reflux disease (GERD), through mechanical augmentation of a weak antireflux barrier and the advantages of minimally invasive access. A critical patient selection for LF, based on thorough preoperative assessment, is important for the management of GERD-patients. The purpose of this study is to provide an overview on the management of GERD-patients treated by primary LF in a specialized center and to illustrate the possible outcome after several years. Methods: Patients were selected after going through diagnostic workup consisting of patient's history and physical examination, upper gastrointestinal endoscopy, assessment of gastrointestinal Quality of Life Index, screening for somatoform disorders, functional assessment by esophageal manometry, (impedance)-24-hour-pH-monitoring, and selective radiographic studies. The indication for LF was based on EAES-guidelines. Either a floppy and short Nissen fundoplication was performed or a posterior Toupet-hemifundoplication was chosen. A long-term follow-up assessment was attempted after surgery. Results: In total, n = 1131 patients were evaluated (603 males; 528 females; mean age; 48.3 years; and mean body mass index: 27). The mean duration between onset of symptoms and surgery was 8 years. Nissen: n = 873, Toupet: n = 258; conversion rateerativ: 0.5%; morbidity 4%, mortality: 1 (1131). Mean follow-up (n = 898; 79%): 5.6 years; pre/post-op results: esophagitis: 66%/12.1%; Gastrointestinal Quality of Life Index: median: 92/119; daily proton pump inhibitors-intake after surgery: 8%; and operative revisions 4.3%. Conclusions: In conclusion, our data show that careful patient selection for laparoscopic fundoplication and well-established technical concepts of mechanical sphincter augmentation can provide satisfying results in the majority of patients with severe GERD.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fuchs, K. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Breithaupt, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Varga, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Babic, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schulz, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meining, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-579144
DOI:	10.1093/dote/doab032
Journal or Publication Title:	Dis. Esophagus
Volume:	35
Number:	1
Date:	2022
Publisher:	OXFORD UNIV PRESS INC
Place of Publication:	CARY
ISSN:	1442-2050
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LOWER ESOPHAGEAL SPHINCTER; ANTIREFLUX SURGERY; NISSEN FUNDOPLICATION; COMPLICATIONS; HEARTBURN; OUTCOMES; REPAIR; TRIAL Multiple languages Gastroenterology & Hepatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57914