760: Longterm Follow-up of Children with Antireflux Surgery: Is Routine Urinalysis Necessary?

Treatment options for morbidly obese patients with complications from large paraesophageal hernias (PEH) are limited. Simple repair of the PEH has a high recurrence rate and may be associated with poor gastric function. We compared a series of patients who underwent repair of large PEH plus gastrostomy tube gastropexy (PEH-GT) with PEH plus sleeve gastrectomy (PEHSG). Retrospective review of patients undergoing PEH-SG and patients with PEH-GT was performed. We assessed symptoms of delayed gastric emptying and reflux postoperatively. In selected patients, gastric-emptying studies and upper gastrointestinal contrast studies were also obtained. All patients with large PEH were repaired laparoscopically with sac resection, primary crural closure using pledgeted sutures, and biologic patch onlay. SG for patients undergoing concomitant weight loss surgery (PEH-SG) was performed with linear endoscopic staplers and staple line reinforcement. Patients undergoing PEH repair alone had a gastrostomy tube gastropexy (PEH-GT). Patients had intraoperative endoscopic evaluation and postoperative contrast swallow studies. In a 12-month period, five patients underwent laparoscopic PEH-SG; two of five had previous antireflux surgery and one of five with a previous diagnosis of delayed gastric emptying. Postoperatively, two patients undergoing PEH-SG had readmission for dehydration and odynophagia. Six-month follow-up body mass index was 32 kg/m2 for the PEH-SG group with no hernia recurrence and complete resolution of gastroesophageal reflux disorder symptoms. Six patients underwent PEH-GT, one for acute incarceration and anemia and four with previous antireflux surgery. Follow up at 8 months demonstrated one recurrence, four of six had severe delayed gastric emptying and reflux, three of six had additional hospitalization for poor oral intake, and three of six underwent reoperation for delayed gastric emptying. There were no perforations, leaks, or deaths in either group. Combined laparoscopic PEH-SG is a clinically reasonable option for patients with morbid obesity with minimal additional risks and decreased incidence of delayed gastric emptying, reflux, and reoperation.

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P-BN25 Redo-Antireflux surgery long term quality of life retrospective study

British Journal of Surgery ◽

10.1093/bjs/znab430.025 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Hesham Mohamed ◽

Martin Kawabata ◽

Cicely Culmer ◽

Keerthanaa Veerapatherar ◽

Sanjoy Basu

Keyword(s):

Quality Of Life ◽

Retrospective Study ◽

Antireflux Surgery ◽

P Value ◽

Long Term Outcomes ◽

Before And After ◽

Related Quality

Abstract Background Gastro-oesophageal reflux disease (GORD) can have a significant effect on patients quality of life, especially in sever cases. Laparoscopic Antireflux surgery is the most common approach which offers promising long-term outcomes. However, Failure of antireflux procedures are reported in 5% to 10% of the patients who might require a redo-antireflux surgery (Redo-ARS). This study aims to assess the long-term outcomes of Redo-Antireflux surgeries regarding symptoms control and patient satisfaction. Methods Retrospective study for patients who underwent Redo-ARS with a single consultant in the south of England. Follow up was done using The GORD Health-Related Quality-of-Life (GORD-HRQL) scale and patients reported their scores before and after the redo-surgery. Exclusion criteria included follow up less than one year and failure of contacting the patient. Results All patients who underwent Redo-ARS between 2009-2019 were enlisted and 18 -out of the identified 22- were included in the study. Overall, There was a significant decrease in heartburn severity after the redo operation with a median reported severity of 4.5 preoperatively which decreased to 2 after the operation with a P value of 0.00062. This was observed in assessment of heartburn symptoms severity during sleep, laying flat, standing and after meals which all showed improvement after the operation with P values <0.005. There was no statistically significant improvement of dysphagia, odynophagia or bloating. The median follow up was 5 years. Conclusions Redo laparoscopic antireflux operations are technically challenging, however, significant heartburn symptoms control is feasible. Further evaluation of types of surgeries and patient selection can guide decisions regarding further management and guidelines.

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Long-term outcome following antireflux surgery in patients with Barrett's oesophagus: The importance of pH monitoring in follow-up

Gastroenterology ◽

10.1016/s0016-5085(03)83225-0 ◽

2003 ◽

Vol 124 (4) ◽

pp. A636

Author(s):

James O'Riordan ◽

Patrick Byrne ◽

Ravi Naryanasamy ◽

Paul W. Keeling ◽

John Reynolds

Keyword(s):

Antireflux Surgery ◽

Ph Monitoring ◽

Barrett’S Oesophagus ◽

Term Outcome ◽

Long Term Outcome ◽

Barrett's Oesophagus

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Clinical and Histologic Follow-Up After Antireflux Surgery for Barrett's Esophagus

Journal of Gastrointestinal Surgery ◽

10.1016/s1091-255x(02)00033-1 ◽

2002 ◽

Vol 6 (4) ◽

pp. 532-539 ◽

Cited By ~ 52

Author(s):

S Bowers

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Antireflux Surgery

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Clinical outcome after laparoscopic Nissen fundoplication in patients with GERD and PPI refractory heartburn

Diseases of the Esophagus ◽

10.1093/dote/doz099 ◽

2020 ◽

Vol 33 (4) ◽

Cited By ~ 2

Author(s):

Katrin Schwameis ◽

Daniel Oh ◽

Kyle M Green ◽

Brenda Lin ◽

Jörg Zehetner ◽

...

Keyword(s):

Partial Response ◽

Antireflux Surgery ◽

Nissen Fundoplication ◽

Poor Response ◽

Satisfaction Score ◽

Laparoscopic Nissen Fundoplication ◽

Key Factors ◽

Excellent Outcome ◽

Laparoscopic Nissen

Summary Typical reflux symptoms that respond well to proton pump inhibitor (PPI) therapy are key factors predictive of an excellent outcome with antireflux surgery for gastroesophageal reflux disease (GERD). Our aim was to evaluate whether poor preoperative heartburn (HB) relief with PPIs was associated with a worse outcome after Nissen fundoplication. Patients with a main symptom of HB and a positive pH-test who had a laparoscopic Nissen fundoplication between January 2008 and December 2014 were included. Prior to surgery, patients graded how effectively their HB symptoms were relieved by PPIs. Three groups were defined: good response (76–100% relief), partial response (26–75% relief) and poor response (0–25% relief). Outcomes and satisfaction were assessed at a minimum of 1 year after fundoplication. There were 129 patients who met inclusion criteria and 75 agreed to participate. The median follow-up was 48 months. Prior to Nissen fundoplication 13 patients had a good HB response to PPI-therapy, 36 had a partial response and 26 had a poor response. All patients were satisfied with their HB relief after fundoplication (mean satisfaction score: 9.5/10) and there was no difference in satisfaction score or heartburn relief between groups. Heartburn symptoms that respond poorly to PPI therapy are reliably relieved with a Nissen fundoplication in patients with objectively confirmed GERD. Patient satisfaction after Nissen fundoplication was excellent and was similar in patients with poor versus excellent HB relief with preoperative PPI therapy. Therefore, antireflux surgery is an option for patients with HB and confirmed GERD regardless of the degree of relief of HB symptoms provided by PPI medications.

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Clinical and histological follow-up after antireflux surgery for Barrett's esophagus

Gastroenterology ◽

10.1016/s0016-5085(01)80213-4 ◽

2001 ◽

Vol 120 (5) ◽

pp. A43-A43

Author(s):

S BOWERS ◽

S MATTAR ◽

K GALLOWAY ◽

C SMITH ◽

J HUNTER

Keyword(s):

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Antireflux Surgery

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