Laparoscopic Nissen Fundoplication

No Results

No Results

processing….

Laparoscopic Nissen fundoplication is now considered the standard surgical approach for treatment of severe gastroesophageal reflux disease (GERD). ^[1] GERD is increasingly prevalent and costly, and it may affect as much as 20% of the US population. ^[2]

The pathophysiology of GERD is due not to acid overproduction but, rather, to mechanical dysfunction centered around the lower esophageal sphincter (LES). Furthermore, the mainstay of GERD treatment, proton pump inhibitors (PPIs), have come under scrutiny because of worrisome side effects. ^{[3, 4]} Laparoscopic magnetic sphincter augmentation of the LES has been proposed as an additional surgical option. Like Nissen fundoplication, it relies on 360° buttressing of the LES, but it may cause fewer long-term adverse effects. ^{[5, 6]}

Dr Rudolf Nissen (1896-1981) described the first fundoplication in the 1950s for treatment of severe reflux esophagitis. His original procedure used a 360° wrap of the fundus of the stomach around the esophagus by plication of both the anterior and posterior walls of the gastric fundus around the lesser curvature. Although the standard Nissen fundoplication has been modified many times, laparoscopic Nissen fundoplication is now considered the standard surgical approach for treatment of GERD. ^[1]

There has been considerable debate about the relative efficacies of antireflux surgery and medical treatment. A systematic review concluded that the two treatment approaches were of similar efficacy. ^[7] Some of the literature suggests that long-term outcomes from antireflux surgery may be superior to those of medical treatment. ^{[8, 9]}

The 2013 guidelines from the American College of Gastroenterology (ACG) stated that “surgical therapy is as effective as medical therapy for carefully selected patients with chronic GERD when performed by an experienced surgeon” (strong recommendation; high level of evidence). ^[10] In appropriately selected patients, laparoscopic reflux surgery may be more cost-effective than lifelong medical treatment. ^{[11, 12]}

Laparoscopic Nissen fundoplication may have advantages over the traditional open approach, including improved cosmesis, reduced morbidity, shorter hospital stay, decreased respiratory complications, and faster recovery. ^{[13, 14, 15]} ; however, it may also be associated with longer operating times. ^[14] With respect to subjective symptoms, long-term outcomes after laparoscopic Nissen fundoplication are comparable to those after open surgery. ^{[16, 17, 18]} Currently, the laparoscopic approach is favored over an open approach unless it is specifically contraindicated.

Indications for laparoscopic antireflux surgery include the following ^{[19, 10]} :

The 2013 ACG guidelines noted that surgery is a treatment option for long-term therapy in GERD patients and that it is as effective as medical therapy in carefully selected patients when performed by an experienced surgeon. ^[10]

In 2012, the US Food and Drug Administration (FDA) approved the LINX Reflux Management System (Torax Medical, St Paul, MN), a magnetic sphincter augmentation system designed to support the LES in much the same way as a fundoplication. Unlike a fundoplication, the device is dynamic, being made up of multiple interlinked titanium-coated rare-earth magnets. Results from initial clinical trials were promising, with excellent results relative to control of reflux and with fewer of the adverse effects (eg, dysphagia, gas-bloat) that may accompany a traditional fundoplication. Additionally, the safety profile seemed to be very good. ^{[20, 21, 6]}

In some cases, removal of the device may become necessary. A laparoscopic technique for accomplishing this has been described. ^[22]

Contraindications for laparoscopic antireflux surgery include the following:

Relative contraindications include previous upper abdominal surgery and severely shortened esophagus. Fundoplication (open or laparoscopic) should be avoided in morbidly obese patients (body mass index [BMI] >35 kg/m²) because of the high failure rates. Instead of fundoplication, gastric bypass should be considered in these patients. Nissen fundoplication should also be avoided in patients with esophageal motility disorders such as achalasia.

Salminen P. The laparoscopic Nissen fundoplication–a better operation?. Surgeon. 2009 Aug. 7 (4):224-7. [Medline].

Patti MG. An Evidence-Based Approach to the Treatment of Gastroesophageal Reflux Disease. JAMA Surg. 2016 Jan 1. 151 (1):73-8. [Medline].

Yu EW, Bauer SR, Bain PA, Bauer DC. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med. 2011 Jun. 124 (6):519-26. [Medline]. [Full Text].

Bhatt DL, Cryer BL, Contant CF, Cohen M, Lanas A, Schnitzer TJ, et al. Clopidogrel with or without omeprazole in coronary artery disease. N Engl J Med. 2010 Nov 11. 363 (20):1909-17. [Medline]. [Full Text].

Ganz RA, Peters JH, Horgan S. Esophageal sphincter device for gastroesophageal reflux disease. N Engl J Med. 2013 May 23. 368(21):2039-40. [Medline].

Aiolfi A, Asti E, Bernardi D, Bonitta G, Rausa E, Siboni S, et al. Early results of magnetic sphincter augmentation versus fundoplication for gastroesophageal reflux disease: Systematic review and meta-analysis. Int J Surg. 2018 Apr. 52:82-88. [Medline].

Ip S, Chung M, Moorthy D, Yu WW, Lee J, Chan JA, et al. Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease: Update. Comparative Effectiveness Reviews, No. 29; Report No.: 11-EHC049-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2011. [Full Text].

Garg SK, Gurusamy KS. Laparoscopic fundoplication surgery versus medical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev. 2015 Nov 5. 11:CD003243. [Medline].

Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Engström C, et al. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol. 2009 Dec. 7 (12):1292-8; quiz 1260. [Medline].

[Guideline] Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013 Mar. 108(3):308-28; quiz 329. [Medline].

Epstein D, Bojke L, Sculpher MJ, REFLUX trial group. Laparoscopic fundoplication compared with medical management for gastro-oesophageal reflux disease: cost effectiveness study. BMJ. 2009 Jul 14. 339:b2576. [Medline]. [Full Text].

Goeree R, Hopkins R, Marshall JK, Armstrong D, Ungar WJ, Goldsmith C, et al. Cost-utility of laparoscopic Nissen fundoplication versus proton pump inhibitors for chronic and controlled gastroesophageal reflux disease: a 3-year prospective randomized controlled trial and economic evaluation. Value Health. 2011 Mar-Apr. 14 (2):263-73. [Medline]. [Full Text].

Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, et al. Evidence-based appraisal of antireflux fundoplication. Ann Surg. 2004 Mar. 239 (3):325-37. [Medline]. [Full Text].

Nilsson G, Larsson S, Johnsson F. Randomized clinical trial of laparoscopic versus open fundoplication: blind evaluation of recovery and discharge period. Br J Surg. 2000 Jul. 87 (7):873-8. [Medline].

Peters MJ, Mukhtar A, Yunus RM, Khan S, Pappalardo J, Memon B, et al. Meta-analysis of randomized clinical trials comparing open and laparoscopic anti-reflux surgery. Am J Gastroenterol. 2009 Jun. 104 (6):1548-61; quiz 1547, 1562. [Medline].

Draaisma WA, Rijnhart-de Jong HG, Broeders IA, Smout AJ, Furnee EJ, Gooszen HG. Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication: a randomized trial. Ann Surg. 2006 Jul. 244 (1):34-41. [Medline]. [Full Text].

Nilsson G, Wenner J, Larsson S, Johnsson F. Randomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux. Br J Surg. 2004 May. 91 (5):552-9. [Medline].

Salminen P, Hurme S, Ovaska J. Fifteen-year outcome of laparoscopic and open Nissen fundoplication: a randomized clinical trial. Ann Thorac Surg. 2012 Jan. 93(1):228-33. [Medline].

[Guideline] Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010 Nov. 24(11):2647-69. [Medline].

Lipham JC, Taiganides PA, Louie BE, Ganz RA, DeMeester TR. Safety analysis of first 1000 patients treated with magnetic sphincter augmentation for gastroesophageal reflux disease. Dis Esophagus. 2015 May-Jun. 28 (4):305-11. [Medline].

Loh Y, McGlone ER, Reddy M, Khan OA. Is the LINX reflux management system an effective treatment for gastro-oesophageal reflux disease?. Int J Surg. 2014. 12 (9):994-7. [Medline].

Stetler JL, Gill S, Patel A, Davis SS Jr, Lin E. Surgical Technique for Laparoscopic Removal of a Magnetic Lower Esophageal Sphincter Augmentation Device. J Laparoendosc Adv Surg Tech A. 2015 Dec. 25 (12):1025-8. [Medline].

Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008 Oct. 135(4):1383-1391, 1391.e1-5. [Medline].

Ip S, Tatsioni A, Conant A, Karagozian R, Fu L, Chew P, et al. Predictors of clinical outcomes following fundoplication for gastroesophageal reflux disease remain insufficiently defined: a systematic review. Am J Gastroenterol. 2009 Mar. 104 (3):752-8; quiz 759. [Medline].

Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999 Aug. 45 (2):172-80. [Medline]. [Full Text].

Waring JP, Hunter JG, Oddsdottir M, Wo J, Katz E. The preoperative evaluation of patients considered for laparoscopic antireflux surgery. Am J Gastroenterol. 1995 Jan. 90 (1):35-8. [Medline].

Fibbe C, Layer P, Keller J, Strate U, Emmermann A, Zornig C. Esophageal motility in reflux disease before and after fundoplication: a prospective, randomized, clinical, and manometric study. Gastroenterology. 2001 Jul. 121 (1):5-14. [Medline].

Yang H, Watson DI, Kelly J, Lally CJ, Myers JC, Jamieson GG. Esophageal manometry and clinical outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg. 2007 Sep. 11 (9):1126-33. [Medline].

Frantzides CT, Carlson MA, Madan AK, Stewart ET, Smith C. Selective use of esophageal manometry and 24-Hour pH monitoring before laparoscopic fundoplication. J Am Coll Surg. 2003 Sep. 197 (3):358-63; discussion 363-4. [Medline].

Castell DO, Vela M. Combined multichannel intraluminal impedance and pH-metry: an evolving technique to measure type and proximal extent of gastroesophageal reflux. Am J Med. 2001 Dec 3. 111 Suppl 8A:157S-159S. [Medline].

Schietroma M, Colozzi S, Pessia B, Carlei F, Di Furia M, Amicucci G. Laparoscopic Nissen fundoplication: The effects of high-concentration supplemental perioperative oxygen on the inflammatory and immune response: A randomised controlled trial. J Minim Access Surg. 2018 Jul-Sep. 14 (3):221-229. [Medline]. [Full Text].

Patterson EJ, Herron DM, Hansen PD, Ramzi N, Standage BA, Swanström LL. Effect of an esophageal bougie on the incidence of dysphagia following nissen fundoplication: a prospective, blinded, randomized clinical trial. Arch Surg. 2000 Sep. 135 (9):1055-61; discussion 1061-2. [Medline]. [Full Text].

Mathavan VK, Yuh JN, Marks JM. Long-term evaluation of patients undergoing laparoscopic antireflux surgery without bougie placement. J Laparoendosc Adv Surg Tech A. 2009 Feb. 19 (1):7-12. [Medline].

Castelijns PSS, van de Poll MCG, Smulders JF. A Modified Technique to Create a Standardized Floppy Nissen Fundoplication Without a Bougie. J Laparoendosc Adv Surg Tech A. 2018 Jul. 28 (7):853-858. [Medline].

DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg. 1986 Jul. 204 (1):9-20. [Medline]. [Full Text].

Donahue PE, Samelson S, Nyhus LM, Bombeck CT. The floppy Nissen fundoplication. Effective long-term control of pathologic reflux. Arch Surg. 1985 Jun. 120 (6):663-8. [Medline].

Kinsey-Trotman SP, Devitt PG, Bright T, Thompson SK, Jamieson GG, Watson DI. Randomized Trial of Division Versus Nondivision of Short Gastric Vessels During Nissen Fundoplication: 20-Year Outcomes. Ann Surg. 2018 Aug. 268 (2):228-232. [Medline].

Malhi-Chowla N, Gorecki P, Bammer T, Achem SR, Hinder RA, Devault KR. Dilation after fundoplication: timing, frequency, indications, and outcome. Gastrointest Endosc. 2002 Feb. 55 (2):219-23. [Medline].

Bais JE, Bartelsman JF, Bonjer HJ, Cuesta MA, Go PM, Klinkenberg-Knol EC, et al. Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomised clinical trial. The Netherlands Antireflux Surgery Study Group. Lancet. 2000 Jan 15. 355 (9199):170-4. [Medline].

Desai AA, Alemayehu H, Dalton BG, Gonzalez KW, Biggerstaff B, Holcomb GW 3rd, et al. Review of the Experience with Re-Operation After Laparoscopic Nissen Fundoplication. J Laparoendosc Adv Surg Tech A. 2016 Feb. 26 (2):140-3. [Medline].

Granderath FA, Kamolz T, Schweiger UM, Pasiut M, Haas CF, Wykypiel H, et al. Long-term results of laparoscopic antireflux surgery. Surg Endosc. 2002 May. 16 (5):753-7. [Medline].

Kapadia S, Osler T, Lee A, Borrazzo E. The role of preoperative high resolution manometry in predicting dysphagia after laparoscopic Nissen fundoplication. Surg Endosc. 2018 May. 32 (5):2365-2372. [Medline].

F Paul (Tripp) Buckley, III, MD, FACS Director, Division of General Surgery, Surgical Director, Heartburn and Reflux Center, The Scott and White Clinic; Assistant Professor of Surgery, Texas A&M Health Science Center

F Paul (Tripp) Buckley, III, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Surgical Education, Michael E DeBakey International Surgical Society, Southwestern Surgical Congress, Texas Surgical Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Torax medical.

Nicole E Sharp, MD Resident Physician, Division of General Surgery, Scott and White Memorial Hospital, Texas A&M Health Science Center College of Medicine

Nicole E Sharp, MD is a member of the following medical societies: American College of Surgeons, Association for Surgical Education, Texas Medical Association

Disclosure: Nothing to disclose.

Kurt E Roberts, MD Assistant Professor, Section of Surgical Gastroenterology, Department of Surgery, Director, Surgical Endoscopy, Associate Director, Surgical Skills and Simulation Center and Surgical Clerkship, Yale University School of Medicine

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Acknowledgments

Medscape Reference thanks SAGES for the video in this article.

Laparoscopic Nissen Fundoplication

Research & References of Laparoscopic Nissen Fundoplication|A&C Accounting And Tax Services
Source

Share on Facebook

Tweet

Follow us