Nissen fundoplication after failure of endoluminal fundoplication: short-term results.

BACKGROUND: Endoluminal fundoplication (ELF) with EsophyX is a new attractive investigational procedure for the control of gastroesophageal reflux disease (GERD). The aim of this work is to evaluate the short-term results of Nissen fundoplication (NF) after failure of ELF. METHOD: During the period April 2007-January 2010, nine patients previously treated with ELF for GERD were submitted to laparoscopic NF for persistent reflux. RESULTS: All patients were symptomatic for GERD, had a pathological esophageal acid exposure at multichannel intraluminal impedance (MII pH/24 h), and all of them were on proton pump inhibitor. Mean duration of the NF was 85 min (range, 56-104). There were no intraoperative complications. One patient had a postoperative mild peritoneal bleeding treated conservatively. After a mean follow-up of 24.9 months (4-34), all patients are asymptomatic for reflux. Two patients have a mild or moderate dysphagia at follow-up. Five patients underwent MII pH/24 h 1 year after surgery. Mean total reflux time was 0.3%, and acid reflux percent time was 0. CONCLUSIONS: Patients with persistent symptomatic reflux after a failing ELF can still undergo NF with good results; the endoluminal procedure does not seem to modify the results of the laparoscopic procedure, although an increased incidence of dysphagia pos-NF may be observed.

Endoluminal fundoplication (ELF) for GERD using EsophyX: a 12-month follow-up in a single-center experience.

BACKGROUND: Several endoscopic antireflux therapies have been proposed to reduce the need for chronic medical therapy or laparoscopic fundoplication for gastroesophageal reflux disease (GERD). Aim of this study was to evaluate the short- and mid-term clinical results of endoluminal fundoplication (ELF) with EsophyX. PATIENTS AND METHODS: From June 2006 to April 2008, 20 patients were enrolled in the study. All the ELFs were performed under general anesthesia. RESULTS: The mean duration of the procedure was 63 min (range 38-105). A median of 14 fasteners was placed. There were no major intraoperative complications. Two patients developed early complications and were treated conservatively. Four patients underwent, within the first year post-ELF, a laparoscopic fundoplication because of persistence of symptoms. One patient was lost to follow-up between 6 and 12 months. Among the other 15 patients who completed 12 months follow-up, the GERD health-related quality of life score decreased from a median of 40 to a median of 10 (p < 0.05), and seven patients were still off proton pump inhibitor. An improvement in esophageal acid exposure was recorded in 16.6% of patients, while in 66.7%, it worsened. CONCLUSIONS: ELF induced improvement of GERD symptoms and patients quality of life in a subgroup of patients with a reduced need for medication. However, it did not significantly change esophageal acid exposure in these patients. The need for revisional standard laparoscopic fundoplication was high.

[Persistent dysphagia after laparoscopic fundoplication]. / La disfagia persistente dopo plastica antireflusso laparoscopica.

Postoperative dysphagia is an important complication after fundoplication for reflux disease, sometimes requiring re-operation. The aim of this retrospective study was to analyse our results after fundoplication performed for gastro-oesophageal reflux disease in order to assess the incidence of postoperative dysphagia, its therapy and the results in the treatment of this complication. We analysed the data of 276 patients who underwent fundoplication for gastro-oesophageal reflux disease. 8.7% of the patients had preoperative dysphagia and 9.1% had major postoperative dysphagia, during the follow-up. No correlation was found between preoperative and persistent postoperative dysphagia. Among patients with persistent postoperative dysphagia, 8 underwent endoscopic pneumatic dilatation, with symptom improvement in 62% of cases. Four patients underwent re-operation. The incidence of clinically significant persistent postoperative dysphagia was 3.6%. Over the same time period, another 11 patients underwent re-operation for persistent dysphagia after antireflux surgery performed elsewhere. Redo surgery was done after a median period of 12 months from the first operation, 77% of re-operated patients obtaining good results. Good results were obtained when an anatomical defect causing dysphagia could be detected. In conclusion, less than 5% of patients submitted to antireflux surgery present persistent postoperative dysphagia. Endoscopic pneumatic dilatation is successful in one-third of the patients. Re-operation gives good results when an anatomical defect causing dysphagia is found. Re-operation for failed fundoplication achieves symptom improvement in a significant percentage of patients (75%).