Funduplicatura con disección extensa de la unión esofagogástrica: lecciones aprendidas y resultados tras 178 pacientes consecutivos / Fundoplication with extensive dissection of the esophagogastric junction: Lessons learned and outcomes from 178 consecutives patients

Introducción: La cirugía antirreflujo se asocia con frecuencia a tasas significativas de recurrencia y complicaciones, habiéndose propuesto varias técnicas quirúrgicas para minimizarlas. El objetivo del estudio es evaluar los resultados a tres años de una funduplicatura con disección extensa de la unión esofagogástrica (UEG). Métodos: Estudio observacional retrospectivo que incluyó a 178 pacientes con enfermedad por reflujo gastroesofágico (ERGE) o hernia de hiato (HH) a los que se les realizó una funduplicatura con disección extensa de la UEG entre 2015 y 2020. La recidiva herniaria, los síntomas y la calidad de vida al primer año y a los tres siguientes de la cirugía fueron evaluados mediante tránsito baritado, endoscopia y cuestionarios para síntomas y calidad de vida (Gastro Esophageal Reflux Disease-Health Related Quality of Life [GERD-HRQL]). Resultados: La tasa de pirosis fue de 7,5 y 10,7% al año y a los tres siguientes, respectivamente, regurgitación de 3,8 y 6,9% y disfagia de 3,7 y 7,6%. La presencia de hernia hiatal se evidenció preoperatoriamente en 55,1% y en 7,8 y 9,6% en el seguimiento y la mediana de la escala GERD-HRQL fue de 27, 2 y 0, respectivamente. No aparecieron casos de telescopaje de la funduplicatura ni síntomas que sugieran lesión vagal. No se encontraron diferencias al comparar los distintos tipos de funduplicatura en términos de recidiva del reflujo, complicaciones o recurrencia de la hernia. Conclusiones: La funduplicatura con disección extensa de la UEG contribuye a su correcto posicionamiento y mejor anclaje, lo que asocia bajas tasas de recidiva herniaria y del reflujo, así como disminuye la posibilidad de telescopaje y lesión vagal.(AU)

Introduction: Antireflux surgery is commonly associated with significant recurrence and complication rates, and several surgical techniques have been proposed to minimize them. The aim of this study is to evaluate the results of a fundoplication with extensive dissection of the esophagogastric junction 1 and 3 years after the procedure.Methods: Retrospective observational study including 178 patients with gastroesophageal reflux disease or hiatal hernia who underwent fundoplication with extensive dissection of the esophagogastric junction between 2015 and 2020. Hernia recurrence, symptoms and quality of life at 1 and 3 years after surgery were assessed by barium transit, endoscopy and questionnaires for symptoms and quality of life (GERD-HRQL). Results: Heartburn rate was 7.5% and 10.7% at 1 and 3 years respectively, regurgitation 3.8% and 6.9% and dysphagia was 3.7% and 7.6%. The presence of hiatal hernia was evident preoperatively in 55.1% and in 7.8% and 9.6% at follow-up and the median GERD-HRQL scale was 27, 2 and 0, respectively. There were no cases of slippage of the fundoplication or symptoms suggestive of vagal injury. No differences were found when comparing the different types of fundoplication in terms of reflux and recurrence or complications. Conclusions: Fundoplication with extensive dissection of the esophagogastric junction contributes to correct positioning and better anchorage of the fundoplication, which is associated with low rates of hiatal hernia and reflux recurrence, as well as absence of slippage and lower possibility of vagal injury.(AU)

Fundoplication with extensive dissection of the esophagogastric junction: Lessons learned and outcomes from 178 consecutives patients.

INTRODUCTION: Antireflux surgery is commonly associated with significant recurrence and complication rates, and several surgical techniques have been proposed to minimize them. The aim of this study is to evaluate the results of a fundoplication with extensive dissection of the esophagogastric junction 1 and 3 years after the procedure. METHODS: Retrospective observational study including 178 patients with gastroesophageal reflux disease or hiatal hernia who underwent fundoplication with extensive dissection of the esophagogastric junction between 2015 and 2020. Hernia recurrence, symptoms and quality of life at 1 and 3 years after surgery were assessed by barium transit, endoscopy and questionnaires for symptoms and quality of life (GERD-HRQL). RESULTS: Heartburn rate was 7.5% and 10.7% at 1 and 3 years respectively, regurgitation 3.8% and 6.9% and dysphagia was 3.7% and 7.6%. The presence of hiatal hernia was evident preoperatively in 55.1% and in 7.8% and 9.6% at follow-up and the median GERD-HRQL scale was 27, 2 and 0 respectively. There were no cases of slippage of the fundoplication or symptoms suggestive of vagal injury. No differences were found when comparing the different types of fundoplication in terms of reflux and recurrence or complications. CONCLUSIONS: Fundoplication with extensive dissection of the esophagogastric junction contributes to correct positioning and better anchorage of the fundoplication, which is associated with low rates of hiatal hernia and reflux recurrence, as well as absence of slippage and lower possibility of vagal injury.

Laparoscopic Toupet Fundoplication After Roux-en-Y Gastric Bypass in Patient with Severe GERD.

BACKGROUND: Up to 22% of the patients, after laparoscopic Roux-en-Y gastric bypass (LRYGB) can complain about gastroesophageal reflux disease (GERD) symptoms, there is little evidence about the most effective treatment of this situation. MATERIALS AND METHOD: This video shows a laparoscopic reintervention after a LRYGB in a 42-year-old woman presenting with untreatable GERD. GERD was treated with maximum doses of PPIs with no effect on the symptoms; the patient had a 24-h pH and impedance manometry that showed an acid and non-acid reflux, and for that reason, we decided to perform a laparoscopic fundoplication. First, very dense adhesions of the greater omentum and the stomach to the parietal peritoneum and the left lobe of the liver are dissected. The gastric remnant is dissected from the pouch, and as the adhesions are very hard, we use a linear stapler device to definitely separate remnant from the pouch, then, short gastric vessels are taken down, to allow mobilization to the medial side of the patient, being careful to preserve the dorsal gastric artery branch of the splenic artery. A Toupet fundoplication is performed with the gastric remnant, and a crural repair is performed with Ethibond stitches reinforced with a polypropylene mesh. RESULTS: After 1 year from the surgery, the patient is asymptomatic, with a normal pH metry and barium swallow. CONCLUSIONS: The laparoscopic fundoplication [1] after a LRYGB is one feasible surgical option intervention, but it must be performed with experienced hands and in a hospital with bariatric/esophagogastric surgery unit, in those patients with severe GERD after LRYGB and with no response to medical treatment.

Laparoscopic Roux-en-Y Gastric Bypass After Open Vertical Banded Gastroplasty in Patient with Severe GERD.

This video shows a laparoscopic reintervention after an open, vertical banded gastroplasty in a 39-year-old woman presenting with untreatable GERD.