ABSTRACT
Gastro-esophageal reflux disease (GERD) patients have a higher prevalence of airway symptoms, such as chronic cough, wheezing, and hoarseness. The therapeutic management of patients with these symptoms is controversial. Therefore, this study aims to perform a systematic review and meta-analysis evaluating the efficacy of anti-reflux surgery for controlling respiratory symptoms related to GERD. A systematic review and meta-analysis was performed. Extraction of the data concerning proportions of participants who were not free of respiratory symptoms related to GERD (cough, wheezing, hoarseness) or not substantially improved at follow-ups (failure to cure) was performed. Of the 3,424 initially screened articles, 68 studies were included for systematic review and 61 were included for meta-analysis, with a cumulative sample size of 3,869 patients. Of all the included patients, after anti-reflux surgery, the general symptoms improvement was 80% (95% CI 75.2-84%). The numbers needed to harm (NNH) and the numbers needed to treat (NNT) were 15.21 and 1.23, respectively. Of the included patients, 83.4% (95% CI 78.3-87.5%) patients reported improvement in cough symptoms after surgery. For the wheezing symptom, 71.5% (95% CI 62.9-78.8%) reported improvement after surgery. Moreover, surgery presented better results in improving respiratory symptoms than medical therapy (risk difference: -0.46; 95% CI -0.77, -0.16). Physicians should strongly consider surgical anti-reflux procedures for controlling respiratory symptoms in GERD patients after proper patient selection. Anti-reflux surgery has shown high efficacy in improving respiratory symptoms related to GERD, even when compared to medical therapy.
Subject(s)
Cough/etiology , Cough/therapy , Digestive System Surgical Procedures/methods , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/surgery , Hoarseness/etiology , Hoarseness/therapy , Pulmonary Disease, Chronic Obstructive/etiology , Pulmonary Disease, Chronic Obstructive/therapy , Respiratory Sounds/etiology , Female , Fundoplication/methods , Humans , Male , Treatment OutcomeABSTRACT
Sao analisados quatro pacientes previamente submetidos a esofagectomia com esofagogastroplastia por megaesofago avancado, que retornaram ao Servico com colelitiase, diagnosticada pela ultrasonografia. Discutem-se as possiveis etiologias da litiase biliar, alem de demonstrar a alteracao anatomica da via biliar principal, com horizontalizacao do coledoco em sua porcao media apos esta intervencao alertando o cirurgiao sobre a possibilidade de se realizar a ligadura inadvertida do coledoco pela sua nova topografia.