Gastro-Esophageal Reflux Test determining Surgical Indication for GERD Patients and Results of Laparoscopic Nissen Fundoplication
EAES Academy. Suwa T. 07/05/22; 363185; P230
Dr. Tatsushi Suwa
Contributions
Contributions
Abstract
Introduction
The indication of laparoscopic anti-reflux surgery for GERD patients is difficult to be determined fairly. We have established “Reflux Test“ as a useful tool to determine surgical treatment for GERD patients.
SURGICAL INDICATION
Reflux Test
At the standing position a patient swallows 300ml barium solution. After total solution goes into stomach, a patient lies down at the flat position. Then a patient changes the position to left lateral decubitus position, flat position, right lateral decubitus position and flat position again every 10 seconds in the order. During this procedure, gastro-esophageal reflux was evaluated and assigned to severe, moderate and slight category. If the reflux was observed slightly up to cervical esophagus, the case was assigned to moderate category. The anti-reflux surgery was considered in the moderate and severe categories.
Results:
We have performed laparoscopic Nissen procedure in 128 cases. Median follow-up period of this study was 81months (2-145 months). In 18 cases (14.1%) PPI was restarted before 6 months after the anti-reflux surgery. In 32 cases (25.0%) PPI was restarted after the anti-reflux surgery during the whole follow-up period of this study. The results of the study have shown that the reflux esophagitis was improved obviously after the anti-reflux surgery even in the PPI restarted group which was analyzed by our endoscopic esophagitis grading score (p<0.001).
Conclusion:
The anti-reflux surgery is most effective for the patients who really have the obvious reflux. The results of the laparoscopic Nissen fundoplication were good and satisfied by the patients mostly.
The indication of laparoscopic anti-reflux surgery for GERD patients is difficult to be determined fairly. We have established “Reflux Test“ as a useful tool to determine surgical treatment for GERD patients.
SURGICAL INDICATION
Reflux Test
At the standing position a patient swallows 300ml barium solution. After total solution goes into stomach, a patient lies down at the flat position. Then a patient changes the position to left lateral decubitus position, flat position, right lateral decubitus position and flat position again every 10 seconds in the order. During this procedure, gastro-esophageal reflux was evaluated and assigned to severe, moderate and slight category. If the reflux was observed slightly up to cervical esophagus, the case was assigned to moderate category. The anti-reflux surgery was considered in the moderate and severe categories.
Results:
We have performed laparoscopic Nissen procedure in 128 cases. Median follow-up period of this study was 81months (2-145 months). In 18 cases (14.1%) PPI was restarted before 6 months after the anti-reflux surgery. In 32 cases (25.0%) PPI was restarted after the anti-reflux surgery during the whole follow-up period of this study. The results of the study have shown that the reflux esophagitis was improved obviously after the anti-reflux surgery even in the PPI restarted group which was analyzed by our endoscopic esophagitis grading score (p<0.001).
Conclusion:
The anti-reflux surgery is most effective for the patients who really have the obvious reflux. The results of the laparoscopic Nissen fundoplication were good and satisfied by the patients mostly.
Introduction
The indication of laparoscopic anti-reflux surgery for GERD patients is difficult to be determined fairly. We have established “Reflux Test“ as a useful tool to determine surgical treatment for GERD patients.
SURGICAL INDICATION
Reflux Test
At the standing position a patient swallows 300ml barium solution. After total solution goes into stomach, a patient lies down at the flat position. Then a patient changes the position to left lateral decubitus position, flat position, right lateral decubitus position and flat position again every 10 seconds in the order. During this procedure, gastro-esophageal reflux was evaluated and assigned to severe, moderate and slight category. If the reflux was observed slightly up to cervical esophagus, the case was assigned to moderate category. The anti-reflux surgery was considered in the moderate and severe categories.
Results:
We have performed laparoscopic Nissen procedure in 128 cases. Median follow-up period of this study was 81months (2-145 months). In 18 cases (14.1%) PPI was restarted before 6 months after the anti-reflux surgery. In 32 cases (25.0%) PPI was restarted after the anti-reflux surgery during the whole follow-up period of this study. The results of the study have shown that the reflux esophagitis was improved obviously after the anti-reflux surgery even in the PPI restarted group which was analyzed by our endoscopic esophagitis grading score (p<0.001).
Conclusion:
The anti-reflux surgery is most effective for the patients who really have the obvious reflux. The results of the laparoscopic Nissen fundoplication were good and satisfied by the patients mostly.
The indication of laparoscopic anti-reflux surgery for GERD patients is difficult to be determined fairly. We have established “Reflux Test“ as a useful tool to determine surgical treatment for GERD patients.
SURGICAL INDICATION
Reflux Test
At the standing position a patient swallows 300ml barium solution. After total solution goes into stomach, a patient lies down at the flat position. Then a patient changes the position to left lateral decubitus position, flat position, right lateral decubitus position and flat position again every 10 seconds in the order. During this procedure, gastro-esophageal reflux was evaluated and assigned to severe, moderate and slight category. If the reflux was observed slightly up to cervical esophagus, the case was assigned to moderate category. The anti-reflux surgery was considered in the moderate and severe categories.
Results:
We have performed laparoscopic Nissen procedure in 128 cases. Median follow-up period of this study was 81months (2-145 months). In 18 cases (14.1%) PPI was restarted before 6 months after the anti-reflux surgery. In 32 cases (25.0%) PPI was restarted after the anti-reflux surgery during the whole follow-up period of this study. The results of the study have shown that the reflux esophagitis was improved obviously after the anti-reflux surgery even in the PPI restarted group which was analyzed by our endoscopic esophagitis grading score (p<0.001).
Conclusion:
The anti-reflux surgery is most effective for the patients who really have the obvious reflux. The results of the laparoscopic Nissen fundoplication were good and satisfied by the patients mostly.
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