Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study

Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study

BACKGROUNDLaparoscopic Nissen fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endo...

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Published in:International journal of surgery (London, England) Vol. 109; no. 11; pp. 3312 - 3321
Main Authors: Habeeb, Tamer A A M, Hussain, Abdulzahra, Podda, Mauro, Aiolfi, Alberto, Kryvoruchko, Igor A, Kalmoush, Abd-Elfattah, Labib, Mohamed F, Mustafa, Fawzy M, Elbelkasi, Hamdi, Hamdy, Ahmed, Abo Alsaad, Mohamed I, Sallam, Ahmed M, Zaitoun, Mohamed A, Negm, Mohamed, Mostafa, Abdelshafy, Abdou Yassin, Mahmoud, Elshahidy, Tamer M, Abdelmonem Elsayed, Ashraf, Mansour, Mohamed I, Elaidy, Mostafa M, Moursi, Adel Mahmoud, Yehia, Ahmed M, Ashour, Hassan, Metwalli, Abd-Elrahman M, Abdelhady, Waleed A, Abdelghani, Amr A, AbdAllah, Ehab S, Ramadan, Alaaedin, Rushdy, Tamer
Format: Journal Article
Language:English
Published: 01-11-2023
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Summary:BACKGROUNDLaparoscopic Nissen fundoplication (LNF) is the gold standard surgical intervention for gastroesophageal reflux disease (GERD). LNF can be followed by recurrent symptoms or complications affecting patient satisfaction. The aim of this study is to assess the value of the intraoperative endomanometric evaluation of esophagogastric competence and pressure combined with LNF in patients with large sliding hiatus hernia (>5 cm) with severe GERD (DeMeester score >100).MATERIALS AND METHODSThis is a retrospective, multicenter cohort study. Baseline characteristics, postoperative dysphagia and gas bloat syndrome, recurrent symptoms, and satisfaction were collected from a prospectively maintained database. Outcomes analyzed included recurrent reflux symptoms, postoperative side effects, and satisfaction with surgery.RESULTSThree hundred sixty patients were stratified into endomanometric LNF (180 patients, LNF+) and LNF alone (180 patients, LNF). Recurrent heartburn (3.9 vs. 8.3%) and recurrent regurgitation (2.2 vs. 5%) showed a lower incidence in the LNF+ group ( P =0.012). Postoperative score III recurrent heartburn and score III regurgitations occurred in 0 vs. 3.3% and 0 vs. 2.8% cases in the LNF+ and LNF groups, respectively ( P =0.005). Postoperative persistent dysphagia and gas bloat syndrome occurred in 1.75 vs. 5.6% and 0 vs. 3.9% of patients ( P =0.001). Score III postoperative persistent dysphagia was 0 vs. 2.8% in the two groups ( P =0.007). There was no redo surgery for dysphagia after LNF+. Patient satisfaction at the end of the study was 93.3 vs. 86.7% in both cohorts, respectively ( P =0.05).CONCLUSIONSIntraoperative high-resolution manometry and endoscopic were feasible in all patients, and the outcomes were favorable from an effectiveness and safety standpoint.
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ISSN:1743-9159
DOI:10.1097/JS9.0000000000000659