195 RANDOMISED TRIAL OF LAPAROSCOPIC NISSEN VS. ANTERIOR 180 DEGREE PARTIAL FUNDOPLICATION—LATE CLINICAL OUTCOMES AT 15–20 YEARS

Abstract Laparoscopic Nissen fundoplication for gastro-oesophageal reflux is followed by troublesome side effects in some patients. Partial fundoplications are proposed for reflux control with less side effects. We reported earlier outcomes from a randomised control trial of Nissen vs. anterior 180° partial fundoplication, with a good outcome following anterior 180° partial fundoplication at up to 10 years follow-up. For this study we determined very late clinical outcomes at up to 20 years follow-up. Methods 107 patients were randomised to Nissen vs. anterior 180° partial fundoplication. 15–20 year follow-up data was available for 79 (41 Nissen, 38 anterior). Outcome was assessed using a standardised clinical questionnaire that included 0–10 analogue scores and yes/no questions to evaluate reflux symptoms, side-effects and overall satisfaction with surgery. Results Heartburn (mean score 3.2 vs 1.4, p = 0.001) and proton pump inhibitor use (41.7% vs 17.1%, p = 0.023) were higher, dysphagia for solids (mean score 1.8 vs 3.3, p = 0.015) was less, and ability to belch was better preserved (84.2% vs 65.9%, p = 0.030) after anterior fundoplication. Overall outcome measures were similar for both groups (mean satisfaction score 8.4 vs 8.0, p = 0.444; 86.8% vs 90.2% satisfied with outcome). Six patients underwent revision from anterior to Nissen fundoplication for reflux, and 5 from Nissen to partial fundoplication for dysphagia. Two further patients underwent revision following Nissen fundoplication for reflux and paraoesophageal hernia respectively. Conclusion At up to 20 years follow-up Nissen and anterior 180-degree partial fundoplication achieve similar rates over overall success, but with a demonstrable trade-off between better reflux symptom control vs. more side-effects after Nissen fundoplication.

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766 PROPHYLAXIS OF POST-FUNDOPLICATION SIDE EFFECTS AFTER LAPAROSCOPIC NISSEN EXTRA SOFT FUNDOPLICATION.

Diseases of the Esophagus ◽

10.1093/dote/doab052.766 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Yevhen Haidarzhi ◽

Andrii Nykonenko

Keyword(s):

Side Effects ◽

Standard Procedure ◽

Surgical Techniques ◽

Partial Fundoplication ◽

Absorbable Sutures ◽

Postoperative Reflux ◽

Total Fundoplication ◽

Laparoscopic Nissen

Abstract Laparoscopic Nissen Fundoplication (LNF) is well-established surgical treatment of GERD with best long-term postoperative outcomes in controlling reflux. Usually it is associated with a high risk of dysphagia, flatulence, inability to belch, bloating, which appear due to total over-tight wrap around esophagus. Partial fundoplication can avoid these effects, but unfortunately does not have the same long-term postoperative reflux control. So, new approach to prophylaxis of post-fundoplication side effects during LNF is needed. Methods Modified extra-soft LNF for GERD during 2016–2020 years were proposed in 75 patients. Prior to the fundoplication wrap formation the operation was performed according to the standard procedure. The proposed surgical techniques were: performing of an extra mobilization of the stomach (mandatory fundus and more ½ part of a large curvature) by crossing the gastro-splenic ligament completely and the gastro-colonic ligament partially and formation of a short extra-soft fundoplication wrap around the esophagus less 1.5 cm in the length with no more than 3 non-absorbable sutures with obligatory fixation to the esophagus. We examined twelve months follow-up. Results Along with the disappearance of GERD symptoms, no post-fundoplication dysphagia, flatulence, inability to belch and bloating were marked in any patient. Routine application of the above-described techniques allowed us to perform a modified LNF in all 75 patients by the extra mobilization of the stomach and formation of an extra-soft total fundoplication wrap with obligatory fixation to the esophagus without mandatory use of a thick (56–60 Fr) gastric fundoplication tube. Conclusion According to our study, in comparison with standard LNF, the proposed surgical techniques is effective in the prevention of post-fundoplication complications (dysphagia, flatulence, inability to belch, bloating) and support routine use of this modified Laparoscopic Nissen Extra Soft Fundoplication in treatment of GERD.

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FA04.01: TEN-YEAR FOLLOW-UP OF A MULTICENTRE, DOUBLE-BLIND RANDOMISED CONTROLLED TRIAL OF LAPAROSCOPIC NISSEN VS ANTERIOR 90° PARTIAL FUNDOPLICATION

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa04.01 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 7-8

Author(s):

Roy Hopkins ◽

Tanya Irvine ◽

Glyn Jamieson ◽

Peter Devitt ◽

David Watson

Keyword(s):

Side Effects ◽

Conflicts Of Interest ◽

Nissen Fundoplication ◽

Controlled Trial ◽

Statistical Significance ◽

Partial Fundoplication ◽

Randomised Trials ◽

Dysphagia Score ◽

Significant Difference

Abstract Background Nissen fundoplications have been reported to have various side effects, which have led to modifications, including partial fundoplications such as anterior 90° wrap. Five-year follow up of randomised trials suggest less side effects following anterior 90° partial compared to Nissen fundoplication, although Nissen fundoplication achieved better reflux control. There is, however, limited longer-term outcome data for Nissen versus 90° anterior partial fundoplication. This study determined outcomes of previous randomised control trials at 10 + years follow-up. Methods From 1999 to 2003, 191 patients were enrolled in two randomised trials comparing anterior 90° partial versus Nissen fundoplication, with outcomes available for 155 (78%) at 10 years. Patients completed annual questionnaires assessing dysphagia, heartburn, medications, satisfaction and other symptoms. Visual analogue scales (0–10), a validated dysphagia score (0–45), Visick score (1–5) and yes/no responses were used. The two trials were combined to evaluate long-term outcomes. Results Following anterior 90° fundoplication patients reported less dysphagia to liquids (0.8 vs 1.8, P = 0.032) and solids (2.0 vs 3.3, P = 0.015). Dysphagia assessed using the 0–45 scale was also less following anterior 90° fundoplication (7.6 vs 12.7, P = 0.023). There was no significant difference in heartburn scores (2.8 vs 1.9 P = 0.053), although more patients were consuming PPIs following anterior 90° fundoplication at 10 years (43.8% vs 20.0% P = 0.004). Overall satisfaction scores were similar for both groups (7.9 vs 7.5, P = 0.215), and the majority considered their original decision for surgery to be correct (78.1% vs. 84.6%, P = 0.387). Reoperation rates were similar (anterior 90° - 13.7% vs Nissen 10.8%, P = 0.796). Conclusion At 10 years follow up, both procedures achieved similar overall success rates as measured by global satisfaction measures, but with more dysphagia following Nissen fundoplication, versus a higher rate of PPI consumption after anterior 90° fundoplication. Heartburn symptom differences failed to reach statistical significance. Disclosure All authors have declared no conflicts of interest.

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Five year comprehensive follow-up on 181 patienis after Laparoscopic Nissen fundoplication

Gastroenterology ◽

10.1016/s0016-5085(01)82156-9 ◽

2001 ◽

Vol 120 (5) ◽

pp. A435-A435

Author(s):

M ANVARI ◽

C ALLEN

Keyword(s):

Nissen Fundoplication ◽

Laparoscopic Nissen Fundoplication ◽

Laparoscopic Nissen

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Quality of life after anti-reflux surgical interventions: possible solutions to the problem

Hirurg (Surgeon) ◽

10.33920/med-15-2001-01 ◽

2020 ◽

pp. 3-25

Author(s):

D. Lukanin ◽

G. Rodoman ◽

M. Klimenko ◽

A. Sokolov ◽

A. Sokolov

Keyword(s):

Quality Of Life ◽

Hiatal Hernia ◽

Antireflux Surgery ◽

Nissen Fundoplication ◽

Laparoscopic Nissen Fundoplication ◽

Partial Fundoplication ◽

Surgical Interventions ◽

Number Of Patients ◽

Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

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Laparoscopic Fundoplication Is Effective Treatment for Patients with Gastroesophageal Reflux and Absent Esophageal Contractility

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-021-05006-0 ◽

2021 ◽

Author(s):

Steven Tran ◽

Ronan Gray ◽

Feruza Kholmurodova ◽

Sarah K. Thompson ◽

Jennifer C. Myers ◽

...

Keyword(s):

Laparoscopic Fundoplication ◽

Symptom Control ◽

Symptom Assessment ◽

Partial Fundoplication ◽

Esophageal Dysmotility ◽

Postoperative Symptoms ◽

Esophageal Contractility ◽

Prospective Database

Abstract Background Anti-reflux surgery in the setting of preoperative esophageal dysmotility is contentious due to fear of persistent long-term dysphagia, particularly in individuals with an aperistaltic esophagus (absent esophageal contractility). This study determined the long-term postoperative outcomes following fundoplication in patients with absent esophageal contractility versus normal motility. Methods A prospective database was used to identify all (40) patients with absent esophageal contractility who subsequently underwent fundoplication (36 anterior partial, 4 Nissen). Cases were propensity matched based on age, gender, and fundoplication type with another 708 patients who all had normal motility. Groups were assessed using prospective symptom assessment questionnaires to assess heartburn, dysphagia for solids and liquids, regurgitation, and satisfaction with surgery, and outcomes were compared. Results Across follow-up to 10 years, no significant differences were found between the two groups for any of the assessed postoperative symptoms. Multivariate analysis found that patients with absent contractility had worse preoperative dysphagia (adjusted mean difference 1.09, p = 0.048), but postoperatively there were no significant differences in dysphagia scores at 5- and 10-year follow-up. No differences in overall patient satisfaction were identified across the follow-up period. Conclusion Laparoscopic partial fundoplication in patients with absent esophageal contractility achieves acceptable symptom control without significantly worse dysphagia compared with patients with normal contractility. Patients with absent contractility should still be considered for surgery.

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Prospective randomized double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication

British Journal of Surgery ◽

10.1046/j.1365-2168.1999.00969.x ◽

1999 ◽

Vol 86 (1) ◽

pp. 123-130 ◽

Cited By ~ 163

Author(s):

D. I. Watson ◽

G. G. Jamieson ◽

G. K. Pike ◽

N. Davies ◽

M. Richardson ◽

...

Keyword(s):

Nissen Fundoplication ◽

Laparoscopic Nissen Fundoplication ◽

Partial Fundoplication ◽

Double Blind Trial ◽

Double Blind ◽

Blind Trial ◽

Anterior Partial Fundoplication ◽

Laparoscopic Nissen

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Drooling Reduction Intervention randomised trial (DRI): comparing the efficacy and acceptability of hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-313763 ◽

2017 ◽

Vol 103 (4) ◽

pp. 371-376 ◽

Cited By ~ 12

Author(s):

Jeremy R Parr ◽

Emma Todhunter ◽

Lindsay Pennington ◽

Deborah Stocken ◽

Jill Cadwgan ◽

...

Keyword(s):

Side Effects ◽

Controlled Trial ◽

Symptom Control ◽

Randomised Trial ◽

Frequency Scale ◽

Skin Patch ◽

Impact Scale ◽

Significant Difference ◽

Secondary Outcomes ◽

Randomised Controlled

ObjectiveInvestigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability.DesignMulticentre, single-blind, randomised controlled trial.SettingRecruitment through neurodisability teams; treatment by parents.ParticipantsNinety children with neurodisability who had never received medication for drooling (55 boys, 35 girls; median age 4 years). Exclusion criteria: medication contraindicated; in a trial that could affect drooling or management.InterventionChildren were randomised to receive a hyoscine skin patch or glycopyrronium liquid. Dose was increased over 4 weeks to achieve optimum symptom control with minimal side-effects; steady dose then continued to 12 weeks.Primary and secondary outcomesPrimary outcome: Drooling Impact Scale (DIS) score at week-4. Secondary outcomes: change in DIS scores over 12 weeks, Drooling Severity and Frequency Scale and Treatment Satisfaction Questionnaire for Medication; adverse events; children’s perception about treatment.ResultsBoth medications yielded clinically and statistically significant reductions in mean DIS at week-4 (25.0 (SD 22.2) for hyoscine and 26.6 (SD 16) for glycopyrronium). There was no significant difference in change in DIS scores between treatment groups. By week-12, 26/47 (55%) children starting treatment were receiving hyoscine compared with 31/38 (82%) on glycopyrronium. There was a 42% increased chance of being on treatment at week-12 for children randomised to glycopyrronium relative to hyoscine (1.42, 95% CI 1.04 to 1.95).ConclusionsHyoscine and glycopyrronium are clinically effective in treating drooling in children with neurodisability. Hyoscine produced more problematic side effects leading to a greater chance of treatment cessation.Trial registration numbersISRCTN75287237; EUDRACT: 2013-000863-94; Medicines and Healthcare Products Regulatory Agency: 17136/0264/001-0003

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Results after Laparoscopic Fundoplication: Does Age Matter?

The American Surgeon ◽

10.1177/000313480607200904 ◽

2006 ◽

Vol 72 (9) ◽

pp. 778-784 ◽

Cited By ~ 6

Author(s):

Sarah M. Cowgill ◽

Dean Arnaoutakis ◽

Desiree Villadolid ◽

Sam Al-Saadi ◽

Demetri Arnaoutakis ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Older Patients ◽

Laparoscopic Fundoplication ◽

Nissen Fundoplication ◽

Younger Patients ◽

Before And After ◽

Laparoscopic Nissen ◽

Age Range

Antireflux fundoplications are undertaken with hesitation in older patients because of presumed higher morbidity and poorer outcomes. This study was undertaken to determine if symptoms of gastroesophageal reflux disease (GERD) could be safely abrogated in a high-risk/reward population of older patients. One hundred eight patients more than 70 years of age (range, 70–90 years) underwent laparoscopic Nissen fundoplications undertaken between 1992 and 2005 and were compared with 108 concurrent patients less than 60 years of age (range, 18–59 years) to determine relative outcomes. Before and after fundoplication, patients scored the severity of reflux and dysphagia on a Likert Scale (0 = minor, 10 = severe). Before fundoplication, older patients had lower reflux scores ( P < 0.01), but not lower dysphagia scores or DeMeester scores. One patient (86 years old) died from myocardial infarction; otherwise, complications occurred infrequently, inconsequentially, and regardless of age. At similar durations of follow-up, reflux and dysphagia scores significantly improved ( P < 0.01) for older and younger patients. After fundoplication, older patients had lower dysphagia scores ( P < 0.01) and lower reflux scores ( P < 0.01). At the most recent follow-up, 82 per cent of older patients rated their relief of symptoms as good or excellent. Similarly, 81 per cent of the younger patients reported good or excellent results. Ninety-one per cent of patients 70 years of age or more versus 85 per cent of patients less than 60 years would undergo laparoscopic Nissen fundoplication again, if necessary. With fundoplication, symptoms of GERD improve for older and younger patients, with less symptomatic dysphagia and reflux in older patients after fundoplication. Laparoscopic fundoplication safely ameliorates symptoms of GERD in elderly patients with symptomatic outcomes superior to those seen in younger patients.

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