Abstract
The cornerstone of gastroesophageal reflux disease (GERD) symptom management includes lifestyle modification and medical therapy. Acid suppressing medications, such as proton pump inhibitors (PPIs), have shown great efficacy in achieving satisfactory symptom control for most patients. Development of complicated GERD while on appropriate medical therapy is a common indication for anti-reflux surgery. Patients with anatomic pathologies also often fail medical therapy and are good surgical candidates. Preoperative evaluation is very important.
Anti-reflux procedures can be broken down into either gastric wraps, sphincter augmentation, endoscopic interventions, or gastric bypass. A practicing foregut surgeon should be able to provide a variety of options for anti-reflux surgery and tailor treatment for each individual patient. The Nissen Fundoplication has become one of the most commonly performed anti-reflux procedures to date. Complete 360-degree fundoplication should be avoided in patients with esophageal motility disorders, as it can lead to severe dysphagia. This has led to the modification of the Nissen fundoplication to partial fundoplication. Magnetic sphincter augmentation involves placement of a magnetic prosthesis around the distal esophagus to bolster the LES. The device used is the LINX Reflux Management System, which gained FDA approval in 2012. GERD disproportionately affects obese patients, with prevalence rates as high as 37–72%. Roux-en-Y gastric bypass has shown positive results in obesity and improvement or resolution of GERD symptoms at 1 year post-operative.
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References
Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976;21(11):953–6. https://doi.org/10.1007/BF01071906.
Sigterman KE, van Pinxteren B, Bonis PA, Lau J, Numans ME. Short-term treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev. 2013;2013(5):CD002095. https://doi.org/10.1002/14651858.CD002095.pub5.
Chiba N, De Gara CJ, Wilkinson JM, Hunt RH. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis. Gastroenterology. 1997;112(6):1798–810. https://doi.org/10.1053/gast.1997.v112.pm9178669.
Gerson LB, Robbins AS, Garber A, Hornberger J, Triadafilopoulos G. A cost-effectiveness analysis of prescribing strategies in the management of gastroesophageal reflux disease. Am J Gastroenterol. 2000;95(2):395–407.
Kwok CS, Arthur AK, Anibueze CI, Singh S, Cavallazzi R, Loke YK. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107(7):1011–9.
Galmiche J-P, Hatlebakk J, Attwood S, et al. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA. 2011;305(19):1969–77. https://doi.org/10.1001/jama.2011.626.
Demeester SR. Barrett’s oesophagus: treatment with surgery. Best Pract Res Clin Gastroenterol. 2015;29(1):211–7. https://doi.org/10.1016/j.bpg.2014.12.004.
Wright RA, Hurwitz AL. Relationship of hiatal hernia to endoscopically proved reflux esophagitis. Dig Dis Sci. 1979;24(4):311–3. https://doi.org/10.1007/BF01296546.
Cooke DT. Belsey mark IV repair. Oper Tech Thorac Cardiovasc Surg. 2013;18(3):215–29. https://doi.org/10.1053/j.optechstcvs.2013.10.001.
Warren HF, Louie BE, Farivar AS, Wilshire C, Aye RW. Manometric changes to the lower esophageal sphincter after magnetic sphincter augmentation in patients with chronic gastroesophageal reflux disease. Ann Surg. 2017;266(1):99–104.
Lundell L, Ruth M, Sandberg N, Bove-Nielsen M. Does massive obesity promote abnormal gastroesophageal reflux? Dig Dis Sci. 1995;40(8):1632–5. https://doi.org/10.1007/BF02212682.
Anand G, Katz PO. Gastroesophageal reflux disease and obesity. Rev Gastroenterol Disord. 2008;8(4):233–9.
Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network. Ann Surg. 2011;254(3):410–22. https://doi.org/10.1097/sla.0b013e31822c9dac.
Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15(9):986–9. https://doi.org/10.1007/s004640000392.
Grant AM, Cotton SC, Boachie C, et al. Minimal access surgery compared with medical management for gastro-oesophageal reflux disease: five year follow-up of a randomised controlled trial (REFLUX). BMJ. 2013;346(7905):1–11. https://doi.org/10.1136/bmj.f1908.
Broeders JA, Roks DJ, Ahmed Ali U, Draaisma WA, Smout AJ, Hazebroek EJ. Laparoscopic anterior versus posterior fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg. 2011;254(1):39–47.
Mardani J, Lundell L, Engström C. Total or posterior partial fundoplication in the treatment of GERD: results of a randomized trial after 2 decades of follow-up. Ann Surg. 2011;253(5):875–8.
Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lönroth H, Olbe L. Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-oesophageal reflux. Br J Surg. 1996;83(6):830–5. https://doi.org/10.1002/bjs.1800830633.
Louie BE, Farivar AS, Shultz D, Brennan C, Vallières E, Aye RW. Short-term outcomes using magnetic sphincter augmentation versus Nissen fundoplication for medically resistant gastroesophageal reflux disease. Ann Thorac Surg. 2014;98(2):498–505. https://doi.org/10.1016/J.ATHORACSUR.2014.04.074.
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Flynn, S.M., Broderick, R.C., Horgan, S. (2020). Surgical Management of Gastroesophageal Reflux Disease. In: Horgan, S., Fuchs, KH. (eds) Management of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-48009-7_7
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