scholarly journals A new technique for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhi Zheng ◽  
Xiaoye Liu ◽  
Chenglin Xin ◽  
Weitao Zhang ◽  
Yan Gao ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Vagus Nerve ◽  
Hiatal Hernia ◽  
Surgical Approach ◽  
Reflux Disease ◽  
Long Term Results ◽  
Perioperative Outcomes ◽  
Life Questionnaire

Abstract Introduction Although the traditional bilateral surgical approach to treat hiatal hernia (HH) with gastroesophageal reflux disease (GERD) can provide local protection of the vagus nerve, the integrity of the entire vagus nerve cannot be evaluated. Therefore, we developed and described the total left-side surgical approach (TLSA), which theoretically reduces injury to the vagus nerve, and described the detailed surgical procedure. Methods Initially, we performed a cadaver study to explore the characteristics of the vagus nerve. Then, we prospectively evaluated the TLSA in 5 patients with HH and GERD between June 2020 and September 2020. Demographic characteristics, surgical parameters, perioperative outcomes, and follow-up findings were analyzed. Results The TLSA was successfully used in five patients (40–64 years old), and no major complications were noted. The median total operative time was 114 min, median blood loss was 50 mL, and median postoperative hospital stay was 3.8 days. Gastrointestinal function recovered within 4 days of surgery in all the patients. The 6-month follow-up gastroscopy examination showed well-established gastroesophageal flap valves. Compared with the baseline results, the 6-month follow-up results showed lower values for the total GerdQ score (12.4 vs. 6.2) and the total esophageal acid exposure time (3.48% vs. 0.38%). Based on the European Organization for Research and Treatment of Cancer quality of life questionnaire-stomach module 52 results, the incidence of dysphagia and flatulence decreased over time after the TLSA. Conclusions The TLSA provides a clear and broad surgical field, less trauma, and rapid recovery; moreover, it is technically simple. Although our results suggest that the TLSA provides safety and short-term efficacy and is feasible for patients with HH and GERD, long-term results from a larger clinical trial are needed to validate these findings. Trial registration ChiCTR2000034028, registration date is June 21, 2020. The study was registered prospectively

scholarly journals A novel surgical approach for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach

2021 ◽  
Author(s):  
Zhi Zheng ◽  
Xiaoye Xiaoye Liu ◽  
Chenglin Xin ◽  
Weitao Zhang ◽  
Yan Gao ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Vagus Nerve ◽  
Hiatal Hernia ◽  
Surgical Approach ◽  
Reflux Disease ◽  
Cadaver Study ◽  
Long Term Results ◽  
Perioperative Outcomes

Abstract BackgroundAlthough the traditional bilateral surgical approach can provide local protection of the vagus nerve, the integrity of the entire vagus nerve cannot be evaluated. Therefore, we developed total left-side surgical approach (TLSA), which theoretically eliminates injury to the vagus nerve, and evaluated its safety and effectiveness.MethodsWe initially performed a cadaver study to explore the characteristics of the vagus nerve, and then prospectively evaluated the TLSA in 5 patients with hiatal hernia and gastroesophageal reflux disease between June 2020 and September 2020. Demographic characteristics, surgical parameters, perioperative outcomes, and follow-up findings were analyzed.ResultsThe patients were 40–64 years old and all 5 patients underwent TLSA successfully without any major complications. The median total operative time was 114 min, the median blood loss was 50 mL, and the median postoperative hospital stay was 3.8 days. Gastrointestinal function recovered within 4 days in all patients. The 6-month follow-up gastroscopy examination revealed well-established gastroesophageal flap valves. Relative to the baseline results, the 6-month follow-up revealed lower values for the total GerdQ score (12.4 vs. 6.2) and the total esophageal acid exposure time (3.48% vs. 0.38%). Based on the EORTC QLQ-STO52 questionnaire results, the incidences of dysphagia and flatulence decreased over time after the procedure.ConclusionsTLSA provides a clear and broad surgical field, less trauma, rapid recovery, and is technically simple. Although our results suggest that the TLSA provides good safety and short-term efficacy, long-term results from a larger clinical trial are needed to validate these findings.Trial registrationChiCTR2000034028, registration date is June 21, 2020.

scholarly journals POSTOPERATIVE DYSPHAGIA AFTER LAPAROSCOPIC FUNDOPLICATION AS A TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
B Carrasco Aguilera ◽  
S Amoza Pais ◽  
T Diaz Vico ◽  
E O Turienzo Santos ◽  
M Moreno Gijon ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Surgical Technique ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Laparoscopic Fundoplication ◽  
Descriptive Study ◽  
Postoperative Dysphagia

Abstract INTRODUCTION Laparoscopic Fundoplication (LF) as a treatment for gastroesophageal reflux disease (GERD) has positive clinical outcomes. However, postoperative dysphagia (PD) may appear as a side effect. Our objective is to analyze PD in patients operated on for LF in our center. MATERIAL AND METHODS Retrospective and descriptive study of patients operated on for GERD from September 1997 to February 2019. RESULTS 248 patients (60.5% men), with a mean age of 49.7 (21-82), were operated. 66.1% of the patients presented associated comorbidities, highlighting obesity (19.8%). 75% manifested typical symptoms, 19% presenting with Barrett’s esophagus. Sliding hiatal, paraesophageal, mixed and complex hernia were diagnosed in 151 (60.9%), 23 (9.3%), 12 (4.8%), and 4 (1.6%) patients, respectively. The LF Nissen was the most frequent technique (91.5%), using a caliper in 46% of the cases. PD was the most frequent symptom, present in 57 (23%) patients. It was resolved with dilation in 9 patients, requiring 6 patients surgical reintervention. In those PD cases, a caliper was used in 28 (49.1%) patients, without finding significant differences between them (P = .586). Nor were there significant differences between PD and obesity (P = .510), type of hiatal hernia (P = .326), or surgical technique (P = .428). After a median follow-up of 50.5 months, quality of life was classified as Visick I-II, III, and IV in 76.6%, 6.9% and 1.2% of the cases, respectively. CONCLUSION No association between PD and the use of calipers, surgical technique or type of hiatal hernia was found in our series.

scholarly journals АЛГОРИТМ ДИАГНОСТИКИ И ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ БОЛЬНЫХ ЖКБ, СОЧЕТАННОЙ С ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНЬЮ И ГРЫЖЕЙ ПИЩЕВОДНОГО ОТВЕРСТИЯ ДИАФРАГМЫ

World Science ◽  
2020 ◽  
Vol 2 (3(55)) ◽  
pp. 21-30
Author(s):  
Велигоцкий А. Н. ◽  
Рыбак И. М. ◽  
Страховецкий В. С. ◽  
Леонов А. В. ◽  
Федоровский С. Г. ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Calculation Method ◽  
Long Term Results ◽  
Original Formula

The results of examination and surgical treatment of 36 patients with cholelithiasis in combination with a hiatal hernia according to the developed algorithm, who were hospitalized and operated on in the clinic from 2014 to 2019, are presented. analysis of the early and long-term results of surgical treatment, it is proved that the surgical treatment of patients with cholelithiasis combined with gastroesophageal reflux disease and hiatal hernia is improved. In practice, the choice of tactics is carried out by the calculation method using the original formula. Thanks to the studies, it was possible to optimize the tactics of surgical treatment of patients with combined pathology.

scholarly journals Predicting factors of recurrence in patients with gastroesophageal reflux disease: a prospective follow-up analysis

2019 ◽  
Vol 12 ◽  
pp. 175628481986454
Author(s):  
Wei-Yi Lei ◽  
Wei-Chuan Chang ◽  
Shu-Hui Wen ◽  
Chih-Hsun Yi ◽  
Tso-Tsai Liu ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Symptom Burden ◽  
Recurrence Risk ◽  
Initial Symptom ◽  
Life Questionnaire ◽  
Predicting Factors ◽  
Psychological Questionnaires

Background: Recurrence of gastroesophageal reflux disease (GERD) is common among patients who are no longer receiving proton pump inhibitors (PPIs). This study investigated factors associated with GERD recurrence. Methods: We included 499 consecutive GERD patients who completed validated reflux and psychological questionnaires before undergoing upper endoscopy. All patients were treated with PPIs and followed up. Results: Recurrence was observed in 89 (30.4%) of 293 patients during the 1-year follow up. Patients with recurrence had a higher prevalence of diabetes mellitus ( p = 0.037), higher baseline GERD Questionnaire (GERDQ) scores ( p = 0.002), and higher Pittsburgh Sleep Quality Index scores ( p = 0.045). Log-rank analysis showed that a GERDQ score of ⩾8 was independently associated with an increased recurrence risk ( p = 0.002). The scores of all psychological questionnaires and health-related quality of life questionnaire worsened more at the end of follow up in patients with recurrence than in those without recurrence. Multivariate analysis revealed that a higher GERDQ score was the only independent risk factor for GERD recurrence ( p = 0.024). GERD patients who have greater initial symptom burden will have a higher recurrence rate after discontinuing PPIs. Conclusions: GERD patients with greater initial symptom burden are more likely to have recurrence after discontinuing PPIs. This study highlights the importance of developing a new strategy to prevent GERD recurrence in the management of this common disorder.

scholarly journals RefluxStopTM, a novel device to address gastroesophageal reflux disease: Short-term results

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
G A Prevost ◽  
C Di Pietro Martinelli ◽  
D Candinas ◽  
Y Borbély
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Open Surgery ◽  
Long Term Results ◽  
Toupet Fundoplication ◽  
Short Term ◽  
Hrql Score ◽  
Conversion To Open Surgery

Abstract Objective To report safety, feasibility, and patient’s functional short-term outcome of novel RefluxStop anti reflux operation. Methods All patients (n = 20) who received laparoscopic implantation of the RefluxStop device from September 2018 to November 2020 in a university hospital were included for retrospective analysis. Incidence of adverse device-effects and procedure-related adverse events are reported as safety endpoints. Feasibility was assessed reporting operation duration, rate of conversion to open surgery and technically correct position of the device by control radiography during patient’s follow up. Subjective (Gastroesophageal Reflux Disease - Health Related Quality of Life (GERD-HRQL) - questionnaires; after 6 weeks and every six-month thereof) and objective data (24h-pH-manometry, barium swallows and upper endoscopies) are reported as functional outcome parameters. Comparison between values at baseline versus post-procedure follow-up are performed using the paired samples T-test, if appropriate. Results Median follow up was 4 (1 – 22) month. Three out of 20 patients had previous upper gastrointestinal surgery (EndoStim implantation). No serious adverse device related events occurred. One patient with dysphagia required balloon dilatation at the oesophageal gastric junction 4 weeks postoperatively. Median duration of surgery was 85 (59-188) minutes. There was no conversion to open surgery. There was significant reduction in the mean of total GERD-HRQL score at baseline compared to 6-weeks after surgery with 23.9 and 4.3 (p < 0.001) as well as at baseline and 6 month after surgery with 28.4 and 6.8 (p = 0.021), respectively. At 6 weeks follow up, all of the subjects had over 50% improvement of the GERD-HRQL score compared to baseline. One patient with acceptable device positioning developed symptom recurrence and received conversion to laparoscopic Toupet fundoplication after 10 months. Conclusion RefluxStop procedure seems to be a safe operation with promising short-term results. For high-level recommendation, further studies looking for long-term results and randomized comparisons to the standard anti reflux procedures like Nissen or Toupet fundoplication are required.

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