Patient Satisfaction after Laparoscopic Nissen Fundoplication—Long-Term Outcomes of Single-Center Study

Up to 33% of the population suffers from gastroesophageal reflux disease (GERD). Given its high prevalence, the negative impact on quality of life, and the possible progression to esophageal cancer, the definitive treatment of GERD should be used more frequently. This study aims to assess long-term patient satisfaction after laparoscopic Nissen fundoplication (LNF). We reviewed the prospectively collected data of patients who underwent LNF for GERD in our department in 2014–2018. Each patient completed a preoperative questionnaire according to GERD Impact Scale (GERD-IS). Postoperative survey consisted of GERD-IS, the need for PPIs, and two “yes or no” questions to assess satisfaction with the outcome. The mean follow-up time was 50 months (21.2–76.3 ± 16.6 months). There was a statistically significant improvement in each GERD-IS question (p < 0.001). A total of 87 patients (78.4%) would recommend the surgery to their relatives. Patients without symptom recurrence and without the need for chronic PPI use after surgery were significantly more likely to recommend surgery and to undergo the procedure again (p < 001). The age of patients did not influence patients’ recommendations (p = 0.75). A total of 17 patients (15.3%) would not undergo LNF again. There was no significant correlation between the answer and patient’s complications or age (p > 0.05). LNF is a good treatment for GERD with a satisfaction rate of 78.4%.

Is There a Role for Elective Early Upper Gastrointestinal Contrast Study in Neurologically Impaired Children following Laparoscopic Nissen Fundoplication?

Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear. We aimed to evaluate the role of scheduled UGI contrast studies to identify early postoperative complications following laparoscopic Nissen fundoplication in NI children. Data for laparoscopic Nissen fundoplications performed in NI children between January 2004 and June 2021 were reviewed. A total of 103 patients were included, with 60 of these being boys. Mean age at initial operation was 6.51 (0.11–18.41) years. Mean body weight was 16.22 (3.3–62.5) kg. Mean duration of follow up was 4.15 (0.01–16.65 years) years. Thirteen redo fundoplications (12.5%) were performed during the follow up period; eleven had one redo and two had 2 redos. Elective postoperative UGI contrast studies were performed in 94 patients (91%). Early postoperative UGI contrast studies were able to identify only one complication: an intrathoracal wrap herniation on postoperative day five, necessitating a reoperation on day six. The use of early UGI contrast imaging following pediatric laparoscopic Nissen fundoplication is not necessary as it does not identify a significant number of acute postoperative complications requiring re-intervention.

633 CONVERSION TO TOUPET FUNDOPLICATION WITH DISTAL GASTRECTOMY AND ROUX-EN-Y GASTROJEJUNOSTOMY AFTER FAILED NISSEN FUNDOPLICATION

Laparoscopic Nissen Fundoplication fails in almost 15% of patients and most of them must be re-operated in order to improve reflux symptoms, esophagitis, or hiatal hernia. Surgical options are to redo LNF, distal gastrectomy alone or combination of both procedures. Redoing LNF, is associated with high rate of postoperative complications and re-failure. Purpose To present the early and medium-term postoperative outcomes of patients submitted to Laparoscopic Toupet Fundoplication combined with Distal Gastrectomy with Roux-en-Y gastrojejunostomy. Methods prospective study including 23 patients submitted to Laparoscopic Nissen Fundoplication who presented recurrence of gastroesophageal reflux after the operation. They were studied with endoscopy, barium swallow, manometry and 24 h pH monitoring in order to determine presence of esophagitis, anatomical deformities, defective Lower Esophageal Sphincter and pathologic acid reflux. Surgical process consisted on re-establishing the anatomy of the esophago-gastric junction, and then perform laparoscopic Toupet fundoplication combined with distal gastrecvtomy and Roux Y gastrojejunostomy. Results After surgery statistically significant improvement regarding heartburn (p &lt; 0.0001), dysphagia (p &lt; 0.0001) and retrosternal chest pain (p &lt; 0.0001) as well as in the endoscopic esophagitis was observed. No significant LES pressure increase after the operation was observed. (from 7.88 + 2.7 to 10.5 + 3.36) (p = 0.15), but the abnormal acid reflux improved significantly after the reoperation, %time pH &lt; 4 decreases from 12.00 + 6.62 to 4.3 + 4.04 (0.0004) and DeMeester score from 44.82 + 21.8 to 11.95 + 5.14 (0.0008) respectively. Conclusion The proposed procedure is safe option to treat successfully patients after failed Nissen fundoplication. Reflux symptoms, esophagitis, presence oh hiatal hernia and reflux score improved after the procedure.

Unusual complication after laparoscopic Nissen fundoplication

We describe a rare complication of Laparoscopic Nissen Fundoplication in the presence of a Gastric greater curvature Plication (LNFGP). An overweight 64-year-old woman was admitted for severe abdominal pain, dysphagia and fever 2 weeks after a Nissen fundoplication. She had pneumoperitoneum on scanner. At laparoscopy, we found a generalized peritonitis secondary to a perforated Nissen wrap in the presence of a gastric greater curvature plication. Gastric bypass and sleeve gastrectomy can be irrelevant in case of moderately and severely obese patients with gastroesophageal reflux disease. Four studies have investigated the risks and rewards of the LNFGP as an alternative. Only one case of leakage has been reported. We present another severe complication: the pylorus stenosis caused by a plication performed too close to the pylorus, causing gastric dilatation in the presence of the wrap, leading to wrap perforation.