scholarly journals 652 LAPAROSCOPIC FUNDOPLICATION IS EFFECTIVE TREATMENT FOR PATIENTS WITH GASTROESOPHAGEAL REFLUX AND ABSENT ESOPHAGEAL CONTRACTILITY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Steven Tran ◽  
Ronan Gray ◽  
Feruza Kholmurdova ◽  
Sarah Thompson ◽  
Jennifer Myers ◽  
...  
Keyword(s):  
Symptom Control ◽  
Symptom Assessment ◽  
Partial Fundoplication ◽  
Esophageal Dysmotility ◽  
Postoperative Symptoms ◽  
Anterior Partial Fundoplication ◽  
Esophageal Contractility ◽  
Control Study

Abstract   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). Emerging evidence suggests fundoplication is safe and effective in patients with esophageal dysmotility. This study aimed to determine the long-term postoperative outcomes following fundoplication in patients with absent esophageal contractility versus normal motility. Methods A case control study was performed, using a prospectively maintained database to identify all (40) patients with absent esophageal contractility on preoperative manometry 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. Outcomes were compared at baseline and at 1, 5 and 10 years follow-up. 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 anterior partial fundoplication in patients with absent esophageal contractility achieves acceptable symptom control without significantly worse dysphagia compared to patients with normal contractility. Patients with medically refractory reflux who have absent contractility should still be considered for surgical intervention.

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

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.

Efficacy of corticosteroid therapy in the treatment of long- lasting olfactory disorders in COVID-19 patients

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
L.A. Vaira ◽  
C. Hopkins ◽  
M. Petrocelli ◽  
J.R. Lechien ◽  
S. Cutrupi ◽  
...  
Keyword(s):  
Treatment Group ◽  
Case Control Study ◽  
Spontaneous Recovery ◽  
Olfactory Function ◽  
Control Group ◽  
Initial Control ◽  
Group A ◽  
Control Study

BACKGROUND: The growing number of COVID-19 patients with long-lasting olfactory disorders makes it necessary to identify effective treatments that enhance the spontaneous recovery of olfactory function. METHODS: Multicentre randomised case-control study that involved 18 patients with COVID-19 related anosmia or severe hyposmia for more than 30 days. Nine patients were prescribed systemic prednisone and nasal irrigation with betamethasone, ambroxol and rinazine for 15 days. The other 9, untreated, patients were used as controls. The olfactory function was evaluated with CCCRC test at 20 and 40 days from the first evaluation. RESULTS: In the control group, a median olfactory score of 20 (IQR 30) was detected at baseline. At the 20-day control there was no significant improvement in olfactory function. The improvement in olfactory performance became significant at the 40-day follow-up compared to baseline scores [60 (IQR 60) versus 20 (IQR 30)]. In the treatment group, patients had a mean olfactory score of 10 (IQR 15) at initial control. At the 20-day control, a significant im-provement in the olfactory scores, compared to the baseline, was detected [70 (IQR 40) versus 10 (IQR 15)]. Olfactory function further improved at 40 days [median score 90 (IQR 50)]. Patients in the treatment group reported significantly higher improvements of the olfactory scores than the controls at both the 20-day [40 (IQR 45) versus 10 (IQR 15)] and 40-day [60 (IQR 40) versus 30 (IQR 25)] evaluations. CONCLUSIONS: Based on the results of this study, the mix of drugs including steroids could represent a useful specific therapy to reduce the prevalence of this long-term morbidity.

scholarly journals De novo malignancies following liver transplantation: a case?control study with long-term follow-up

2006 ◽  
Vol 20 (5) ◽  
pp. 617-623 ◽  
Author(s):  
Francis Y Yao ◽  
Manjushree Gautam ◽  
Caren Palese ◽  
Raquel Rebres ◽  
Norah Terrault ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Case Control Study ◽  
De Novo ◽  
Case Control ◽  
Long Term Follow Up ◽  
Control Study

Is pharyngeal pouch stapling superior to open pharyngeal pouch repair? An analysis of a single institution's series

2016 ◽  
Vol 130 (9) ◽  
pp. 873-877 ◽  
Author(s):  
E Agalato ◽  
J Jose ◽  
R J England
Keyword(s):  
Surgical Procedures ◽  
Symptom Control ◽  
Open Approach ◽  
Pharyngeal Pouch ◽  
Female Ratio ◽  
Open Procedure ◽  
Long Term Follow Up ◽  
Male To Female

AbstractBackground:Endoscopic stapling has become the primary procedure for pharyngeal pouch surgery because it is quick, less invasive and safe, but less is known about long-term outcomes.Method:Medical records were reviewed to compare rates of morbidity, operative failure, symptom control and revision surgery between open and closed procedures.Results:A total of 120 pharyngeal pouch procedures, carried out on 97 patients from 2000 to 2014, were studied. These included 80 endoscopic stapling and 40 open procedures. Twelve patients had complications (15 per cent) and there was one mortality (1.2 per cent) in the endoscopic stapling group. Ten patients (25 per cent) developed complications in the open procedure group, with no mortalities. Symptom recurrence was significantly greater in the endoscopic stapling group (26 per cent) than in the open procedure group (7.5 per cent). Multiple surgical procedures were required for 22 endoscopically stapled patients (32 per cent); none were required in the open procedure group. Although the male-to-female ratio for pharyngeal pouch incidence was 2:1, the ratio for multiple surgical procedures was 10:1.Conclusion:Endoscopic stapling outcomes are not as good as those following an open approach on long-term follow up, and the early advantages are eliminated if pouch excision is avoided.

Long-term follow-up review of cases of Parkinson's disease after unilateral or bilateral thalamotomy

1984 ◽  
Vol 60 (5) ◽  
pp. 1033-1044 ◽  
Author(s):  
Keizo Matsumoto ◽  
Fumio Shichijo ◽  
Tsuneharu Fukami
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Medical Treatments ◽  
Content Type ◽  
Bilateral Surgery ◽  
Long Term Follow Up ◽  
Grade 3 ◽  
Control Study

✓ Follow-up reviews were carried out on 86 of 103 patients with Parkinson's disease who underwent unilateral or bilateral ventrolateral (VL) thalamotomy in the period from 1964 to 1969. Of these 86 patients, 64 received unilateral surgery, and 22 bilateral surgery. The follow-up periods were at least 10 years from the operation (from the second intervention in cases with bilateral procedures). In the group that received unilateral surgery, no progression after surgery was seen in three of six patients classified preoperatively in Grade I (Hoehn and Yahr's Grade 1), nine of 20 patients in Grade IIa (Hoehn and Yahr's Grade 2), 13 of 23 patients in Grade IIb (Hoehn and Yahr's Grade 3), and six of 15 patients in Grade III (Hoehn and Yahr's Grade 4). In the group that received bilateral surgery, one of three patients in Grade I and one of 11 patients in Grade IIa before the second intervention maintained continuous full social activities for over 10 years after the second surgery without any medication. In addition, eight of 11 patients classified preoperatively in Grade IIa and five of eight patients in Grade IIb seemed to show no progression after the second operation; four of 22 patients stopped taking their medication because of improvement in their symptoms. No patient who received bilateral surgery had progression of the disease to death. Observations suggested the efficacy of thalamic surgery, not only for improvement of motor symptoms but also for reducing progression of the disease, although no control study was made. Thalamotomy is still used to treat Parkinson's disease as an alternative to current medical treatments, such as L-dopa therapy.

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