Hiatal hernia, Barrett’s esophagus, and long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux

Background : Obesity is correlated with several comorbidities, including gastroesophageal reflux disease. Its main complications are detectable by endoscopy: erosive esophagitis and Barrett's esophagus. Aim : To correlate erosive esophagitis and hiatal hernia with the degree of body mass index (BMI). Method : Was performed a retrospective analysis of 717 preoperative endoscopic reports of bariatric patients. Fifty-six (8%) presented hiatal hernia, being 44 small, nine medium and five large. Esophagitis was classified by Los Angeles classification. Results : There was no correlation between the presence and dimension of hiatal hernia with BMI. One hundred thirty-four (18.7%) patients presented erosive esophagitis. Among them, 104 (14.5%) had esophagitis grade A; 25 (3.5%) grade B; and five (0.7%) grade C. When considering only the patients with erosive esophagitis, 77.6% had esophagitis grade A, 18.7% grade B and 3.7% grade C. Were identified only two patients with Barrett's esophagus (0,28%). Conclusion : There was a positive correlation between the degree of esophagitis with increasing BMI.

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RADIOFREQUENCY ABLATION IN TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE WITH BARRETT’S ESOPHAGUS

Vestnik of Russian military medical Academy ◽

10.17816/brmma13062 ◽

2019 ◽

Vol 21 (1) ◽

pp. 117-122

Author(s):

K V Puchkov ◽

E V Khabarova ◽

E S Tishchenko

Keyword(s):

Radiofrequency Ablation ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hiatal Hernia ◽

Barrett’S Esophagus ◽

Reflux Disease ◽

Barrett's Esophagus ◽

Antireflux Surgery ◽

Low Grade ◽

Results Of Treatment

OBJECTIVE: To evaluate results of treatment of patients with Barrett’s esophagus, including radiofrequency ablation of columnar epithelium with antireflux surgery. METHODS: We treated82 patients with gastroesophageal reflux disease withBarrett’s esophagus between 2011 and 2018. 4 patients had low-grade dysplasia, 63 patients had hiatal hernia. We performed laparoscopic Toupet 2700 fundoplication in 58 of these patients.This allowedto perform radiofrequency ablation (RFA) procedure 2-3 months later in 27 of these patients. In 12 patients without radiological signs of hiatal hernia we performed RFA as the first treatment step. Follow-up endoscopy was performed 3,6 and 12 months after RFA. RESULTS: Metaplasia eradication wasachieved in 97,5% after 1 procedure and in 100% after 2 procedures. 6 months after treatment recurrence of metaplasia was registered in 2,4% patients. CONCLUSIONS: Changing security profile of new endoscopic treatment methods indicates the need for new strategies for Barrett’s esophagus. The most effective scheme is two-step treatment including antireflux surgery and radiofrequency ablation in combination with drug therapy.

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Barrett’s Esophagus in Romania: what do we know?

Romanian Journal of Internal Medicine ◽

10.2478/rjim-2020-0007 ◽

2020 ◽

Vol 58 (3) ◽

pp. 111-118

Author(s):

Claudia Piloiu ◽

Dan L. Dumitrascu

Keyword(s):

Risk Factors ◽

Gastroesophageal Reflux ◽

Hiatal Hernia ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Classification Systems ◽

Endoscopic Techniques ◽

Manual Search ◽

The Status ◽

H Pylori

AbstractBackground and aims. The incidence of Barrett’s Esophagus (BE) is increasing worldwide, thus diagnosis is becoming a major key of interest in preventing esophageal adenocarcinoma. Because the status of BE in Romania is unclear, we performed a narrative review to comprehensively evaluate all published articles on BE from Romania.Methods. We conducted a systematic literature search of PubMed data base and of all Romanian medical journals. The abstracts and the titles of the identified studies were reviewed to exclude the studies that did not answer the search question. In addition we performed a manual search to identify articles on this topic published earlier in local journals or not indexed on internet.Results. A total of 17 articles were found. 8 studies and 9 reviews were identified, with a total of 8,829 participants enrolled. The results showed that the median age ranges between 54–59 years, with a predominance for male sex, the main risk factors, such as gastroesophageal reflux disease, obesity, smoking, hiatal hernia, are also present in Romania and infection with H. pylori has a protective effect. The diagnosis of Barrett’s esophagus in Romania is established in agreement with international guidelines.Conclusions. There are not many publications on BE in Romania. However the data in this country are similar to those reported in other countries. The management is carried out according to standard guidelines. Diagnosing BE relies on endoscopic techniques and classification systems. Risk factors such as gastroesophageal reflux, hiatal hernia, obesity and Helicobacter pylori are considered in Romanian articles. More studies are welcome on this matter in our country.

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Gastroesophageal Reflux Disease and Hiatal Hernia

10.2310/tywc.2046 ◽

2020 ◽

Author(s):

Kyle A. Perry ◽

Vivian L. Wang

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hiatal Hernia ◽

Barrett’S Esophagus ◽

Reflux Disease ◽

Barrett's Esophagus ◽

Paraesophageal Hernia ◽

Nissen Fundoplication ◽

Gastroesophageal Junction ◽

Symptomatic Gerd

Gastroesophageal reflux disease (GERD) is common, affecting approximately 18 to 27% of adult Americans, and can have a considerable impact on quality of life. Hiatal hernias are present in 80% of patients with symptomatic GERD. This review covers the basic pathophysiology, evaluation, and treatment algorithms for patients with GERD and hiatal hernia. Figures show normal gastroesophageal junction anatomy, treatment algorithm for patients with symptomatic GERD, schematic and endoscopic images of long segment Barrett's esophagus, a normal barium esophagogram, esophageal intraluminal pressures assessed by esophageal manometry, test results from a 48-hour wireless pH study, laparoscopic Nissen fundoplication, laparoscopic gastroesophageal junction reinforcement, classification of paraesophageal hernia, and endoscopic view of Cameron ulcers at the level of the diaphragm in the setting of a type III paraesophageal hernia. Tables list risk factors for GERD and a standardized approach to Nissen fundoplication. This review contains 10 figures, 3 tables, and 68 references. Keywords: Gastroesophageal reflux disease, GERD, hiatal hernia, paraesophageal hernia, anti-reflux surgery, Nissen fundoplication, Barrett's esophagus, manometry, pH study

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Gastroesophageal reflux disease with non-esophageal manifestations, the formation of Barrett’s esophagus on the background of a hiatal hernia

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-163-3-16-23 ◽

2019 ◽

Vol 163 (3) ◽

pp. 16-23

Author(s):

O.V. Tsygankova ◽

◽

L.D. Latyntseva ◽

T.I. Batluk ◽

T.K. Gaskina ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hiatal Hernia ◽

Barrett’S Esophagus ◽

Reflux Disease ◽

Barrett's Esophagus

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Gastroesophageal Reflux Disease and Hiatal Hernia

10.2310/surg.2046 ◽

2020 ◽

Author(s):

Kyle A. Perry ◽

Vivian L. Wang

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Hiatal Hernia ◽

Barrett’S Esophagus ◽

Reflux Disease ◽

Barrett's Esophagus ◽

Paraesophageal Hernia ◽

Nissen Fundoplication ◽

Gastroesophageal Junction ◽

Symptomatic Gerd

Gastroesophageal reflux disease (GERD) is common, affecting approximately 18 to 27% of adult Americans, and can have a considerable impact on quality of life. Hiatal hernias are present in 80% of patients with symptomatic GERD. This review covers the basic pathophysiology, evaluation, and treatment algorithms for patients with GERD and hiatal hernia. Figures show normal gastroesophageal junction anatomy, treatment algorithm for patients with symptomatic GERD, schematic and endoscopic images of long segment Barrett's esophagus, a normal barium esophagogram, esophageal intraluminal pressures assessed by esophageal manometry, test results from a 48-hour wireless pH study, laparoscopic Nissen fundoplication, laparoscopic gastroesophageal junction reinforcement, classification of paraesophageal hernia, and endoscopic view of Cameron ulcers at the level of the diaphragm in the setting of a type III paraesophageal hernia. Tables list risk factors for GERD and a standardized approach to Nissen fundoplication. This review contains 10 figures, 3 tables, and 68 references. Keywords: Gastroesophageal reflux disease, GERD, hiatal hernia, paraesophageal hernia, anti-reflux surgery, Nissen fundoplication, Barrett's esophagus, manometry, pH study

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A Single Institution's Experience and Journey with over 1000 Laparoscopic Fundoplications for Gastroesophageal Reflux Disease

The American Surgeon ◽

10.1177/000313481207800928 ◽

2012 ◽

Vol 78 (9) ◽

pp. 917-925 ◽

Cited By ~ 6

Author(s):

Alexander Rosemurgy ◽

Harold Paul ◽

Lauren Madison ◽

Kenneth Luberice ◽

Natalie Donn ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Laparoscopic Fundoplication ◽

Symptom Control ◽

Conventional Laparoscopic ◽

Efficacious Treatment ◽

Hospital Stays

There have been great advances in laparoscopic surgery for gastroesophageal reflux disease (GERD), including laparoendoscopic single-site (LESS) surgery. This study details our experience with over 1000 patients undergoing fundoplication for GERD and the journey therein. A total of 1078 patients have been prospectively followed after fundoplication. Patients scored the frequency/severity of symptoms using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). We compared the outcomes of the first and last 100 patients. Median data are reported. Of 1078 patients, 943 underwent conventional laparoscopic fundoplication and 135, most recently, underwent LESS fundoplication. Before fundoplication, patients noted frequent/severe symptoms (e.g., heartburn: frequency = 8, severity = 8). Fundoplication ameliorated frequency/severity of symptoms (e.g., heartburn: frequency = 2, severity = 0; less than preoperatively, P < 0.05). Relative to our first 100 patients, patients after LESS surgery had similar symptom control (e.g., heartburn: frequency = eight to two vs eight to zero, severity = eight to one vs six to one) but had shorter hospital stays (2 vs 1 day, P < 0.05) and had no apparent scars. Laparoscopic fundoplication provides durable and efficacious treatment for GERD; long-term symptom resolution and patient satisfaction support its continued application. The advent of LESS surgery advances surgeons’ abilities to provide safe and salutary care while promoting cosmesis.

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Modern aspects of treatment of hiatal hernia and its main complications

Zaporozhye Medical Journal ◽

10.14739/2310-1210.2021.2.209629 ◽

2021 ◽

Vol 23 (2) ◽

pp. 207-213

Author(s):

A. Yu. Usenko ◽

O. S. Tyvonchuk ◽

О. P. Dmytrenko ◽

I. S. Tereshkevych ◽

I. V. Babii

Keyword(s):

Surgical Treatment ◽

Hiatal Hernia ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Esophageal Stricture ◽

Laparoscopic Fundoplication ◽

Argon Plasma Coagulation ◽

Argon Plasma ◽

Type I ◽

Two Stage

The aim. To evaluate the features and results of minimally invasive surgical treatment of patients with hiatal hernia (HH) and its main complications using modern endoscopic and laparoscopic technologies. Materials and methods. The treatment results of 244 patients with HH and its main complications are given. 28 (11.5 %) patients had a combination of HH with Barrett’s esophagus, and 34 (13.9 %) patients had a combination of HH with esophageal stricture. In 62 patients with complications of HH, two-stage treatment tactics was used. Complete laparoscopic fundoplication was performed in 185 (75.8 %) patients, posterior partial Toupet fundoplication – in 59 (24.2 %) patients. Laparoscopic posterior crurography was performed in 198 (81.1 %) patients. In 7 (2.9 %) posterior crurography was supplemented by anterior. Teflon gaskets were used in 25 (10.3 %) patients during posterior crurography. Synthetic mesh prostheses were implanted in 14 (5.7 %) patients. Results. In patients with esophageal stricture, the effect was observed after the second session of bougienage or hydro-dilation in 70.6 % of cases, after the third session - in the remaining cases. In Barrett's esophagus, a single session of argon plasma coagulation was radical in 100 % of patients with a lesion size less than 1 cm and in 85 % of patients with lesions of 1 cm to 2 cm in size. Recurrence of type III HH occurred more often than type I. The surgery required sufficient mediastinal dissection and mobilization for an adequate esophagus pull-through. In the surgical treatment of type IV HH, the use of composite diaphragmatic meshes was considered. The effectiveness of antireflux surgical intervention, as well as prevention of specific complications was depended on the technical features of the fundoplication cuff formation. Conclusions. In the treatment of Barrett’s esophagus or esophageal stricture in combination with HH, the two-stage tactics is optimal: stage I – ablation or dilatation, and stage II – laparoscopic antireflux surgery. Laparoscopic fundoplication is an effective and safe method for treatment of patients with HH.

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