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Trends in laparoscopic anti-reflux surgery: a Korea nationwide study

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Abstract

Background

In 2014, the results derived from the nationwide data of the Korean Anti-reflux Surgery Study (KARS) demonstrated short-term feasibility and safety of anti-reflux surgery. This study aimed to update the longer-term safety and feasibility of laparoscopic anti-reflux surgery up to 1-year follow-up with the KARS nationwide cohort.

Methods

The data of 310 patients with GERD who received anti-reflux surgery up to 2018 were analyzed. Baseline patient characteristics, postoperative symptom resolution, and postoperative complications were evaluated at postoperative 3 months and 1 year using the questionnaire designed by KARS. We divided the patients into two groups according to the operation period (up to and after 2014) to identify changes in the trends of the characteristics of surgical patients and operative qualities.

Results

The typical preoperative symptoms were present in 275 patients (91.7%), and atypical symptoms were present in 208 patients (71.0%). Ninety-seven (35.5%) and 124 patients (46.1%) had inadequate PPI responses and hiatal hernia, respectively. At postoperative 1 year, typical and atypical symptoms were either completely or partially controlled in 90.3% and 73.5.0% of patients, respectively. Moderate-to-severe dysphagia, inability to belch, gas bloating, and flatulence at postoperative 1 year were identified in 23.5%, 29.4%, 23.2%, and 22.0% of patients, respectively. The number of surgical patients continuously increased from 2011 to 2018 in Korea. The proportion of patients with hiatal hernia and comorbidities increased (p < 0.01, p = 0.053), and the operation time decreased significantly (p < 0.01) in the late period (2015–2018) as compared with the early period (2011–2014). Symptom control and complication rate were equivalent between the two periods.

Conclusions

Anti-reflux surgery was effective with > 90% of typical symptom resolution and posed a comparable postoperative complication rate with those in Western studies with mid-term to long-term follow-up. This result supports the feasibility and safety of anti-reflux surgery as a treatment for GERD in the Korean population.

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Funding

This study was supported by a Grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant No. HC17C0050), and by a Grant from Korea University.

Author information

Author notes

  1. Min Seo Kim and Youjin Oh have contributed equally to this work.

  2. Sungsoo Park and Sang-Uk Han have contributed equally to this work.

Authors and Affiliations

  1. Korea University College of Medicine, Seoul, Republic of Korea

    Min Seo Kim & Youjin Oh

  2. Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea

    Jun-Hyun Lee, Jin-Jo Kim, Kyo Young Song & Dong Jin Kim

  3. Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea

    Joong-Min Park

  4. Department of Surgery, Ajou University School of Medicine, 206 WorldCup-ro, Yeongtong-gu, Suwon, 443-749, Republic of Korea

    Sang-Uk Han

  5. Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea

    Seung Wan Ryu

  6. Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea

    Kyung Won Seo

  7. Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hyoung-Il Kim

  8. Division of Upper Gastrointestinal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Inchon-ro 73, Seongbuk-gu, Seoul, 136-705, Republic of Korea

    Sungsoo Park

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  1. Min Seo Kim
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Consortia

Korean Anti-reflux Surgery Study (KARS) group

Contributions

This manuscript has been read and approved by all authors. Study conception and design: SP and SWH. Data collection: JHL, HMP, JJK, KYS, SWR, KWS, HK, DJK, SP, and SUH. Statistical analysis: YO and MSK. Data interpretation: YO, MSK, and SP. Drafting of the manuscript: MSK and YO. Critical revision: SP and SUH.

Corresponding authors

Correspondence to Sungsoo Park or Sang-Uk Han.

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Disclosures

Sungsoo Park was supported by a Grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant No. HC17C0050), and by a Grant from Korea University. Min Seo Kim, Youjin Oh, Jun-Hyun Lee, Joong-Min Park, Jin-Jo Kim, Kyo Young Song, Seung Wan Ryu, Kyung Won Seo, Hyoung-Il Kim, and Sang-Uk Han have no conflicts of interest or financial ties to disclose.

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Kim, M.S., Oh, Y., Lee, JH. et al. Trends in laparoscopic anti-reflux surgery: a Korea nationwide study. Surg Endosc 35, 4241–4250 (2021). https://doi.org/10.1007/s00464-020-07909-6

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