Salvatore Marano

Functional Evaluation at 1-Year Follow-Up of Laparoscopic Nissen-Rossetti Fundoplication

Laparoscopic Nissen fundoplication is currently the gold standard for surgical treatment of gastroesophageal reflux disease. The aim of this study was to present our experience with this procedure at 1 year of follow-up. Forty patients were operated on between January 2006 and July 2007, and 30 underwent a 24-hour postoperative pH-metry study. Ninety-two percent of the patients were asymptomatic at a follow-up of 12 months. All pH-metric parameters improved. DeMeester and Johnsons score was reduced from 44.7 to 7.75; endoscopy with histologic samples revealed the healing of esophagitis in all patients; 4 (13%) patients complained of dysphagia, which resolved within 1 month after surgery. Twenty-seven (90%) patients were completely satisfied by their surgical results. One year after surgery, 24-hour ph-metric results show that laparoscopic Nissen fundoplication can completely control acid reflux with relatively few complications and a high degree of patient satisfaction.

Quality of life after Nissen-Rossetti fundoplication.

Background: We investigated Quality of Life (QoL) and Johnsson & DeMeester score of patients after Nissen-Rossetti fundoplication. Materials and Methods: From January 2007 to June 2008, 43 patients with chronic gastroesophageal reflux underwent laparoscopic Nissen-Rossetti fundoplication; 7 were lost during the follow-up. Patients underwent endoscopy, 24-hour pH-metry, Gastroesophageal Reflux Disease-Health-Related Quality-of-Life (GERD-HRQL), and Short Form 36 (SF-36) questionnaires preoperatively, 6 months, and 12 months after surgery. Results: Endoscopic findings revealed complete healing of esophagitis in all patients. Barrett esophagus was still present. Six patients reported persistence of symptoms but postoperative pH-metry and endoscopy showed the absence of reflux; 2 patients (5.5%) were still on proton pump inhibitor therapy at 12 months. Seven patients (19.4%) reported dysphagia for solids for at least 3 months. Readmission for dysphagia was required for 2 (5.5%) and 1 patient underwent endoscopic dilatation. At 6 and 12 months, no dysphagia was reported. During the follow-up, no gas-bloat syndrome was reported. The Johnsson & DeMeester score and QoL measurement obtained from GERD-HRQL and SF-36 revealed a significant improvement in the related domain. At 6 months, 23 patients (63.8%) were completely satisfied and after 12 months, 30 patients (83.3%) were satisfied. Conclusions: Nissen-Rossetti fundoplication is safe and effective for the treatment of GERD, improving QoL.

Two-year subjective, objective, quality of life, and endoscopic follow-up after laparoscopic Nissen-Rossetti in patients with columnar-lined esophagus.

Introduction: Barrett esophagus (BE) is a complication of gastroesophageal reflux disease. We wish to determine the effects of surgery on the histology of the esophageal mucosa and evaluate Quality of Life. Materials and Methods: Twenty-seven patients with columnar-lined esophagus (CLE) metaplasia underwent laparoscopic Nissen-Rossetti fundoplication. Patients were submitted to close follow-up. Results: One patient voluntarily left follow-up after surgery. CLE was still present in 18 patients (66.6%); no patient developed dysplasia or esophageal adenocarcinoma. Two patients with gastric metaplasia and 1 patient with intestinal metaplasia had regression at 12 and 24 months after surgery (11.1%). DeMeester and Johnson score decreased from 38.69 (SD±51.44) to 11.99 (SD±18.08) at 6 months, 12.69 (SD±12.91) at 12 months, and it was 11.38 (SD±6.43) at 24 months. Preoperative gastroesophageal reflux disease-health related quality of life was 19.90 (SD±18.54), 9.80 (SD±8.77) at 6 months, 9.57 (SD±9.14) at 12 months, and 11.53 (SD±6.48) at 24 months. Short form-36 measurement showed significant improvement. Conclusions: Management of CLE requires multidisciplinary approach. Medical therapy does not prevent biliary reflux into the esophagus. Surgical therapy is effective and long lasting. It should be performed by experienced surgical teams.

Surgical Treatment of Gastroesophageal Reflux Disease

Gastro-esophageal reflux disease (GERD) is “a condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications” (Vakil et al 2006) and represents one of the fastest growing disease affecting the alimentary tract. Recently studies on the epidemiology of GERD demonstrating that GERD is a highly prevalent disorder with 10-20% of individuals affected in western civilization (Dent et al 2005). When GERD is defined as twice weekly reflux over several months, 10-20% of individuals in Western civilization are affected, which is significantly higher than in Asian population (5%) (Bonatti et al 2008). In a large prospective American cohort study is reported that 25% of investigated individuals experienced nocturnal reflux symptoms (Fass et al 2005). A recent population-based study demonstrated the prevalence of reflux symptoms to be 44% with 24% of individuals experiencing symptoms for two days or more per week. The prevalence of oesophagitis and Barrett’s oesophagus was 12% and 1.3% respectively, irrespective of symptoms (Zagari et al 2008).Thirty-three per cent of individuals with oesophagitis and 46% with Barrett’s oesophagus were asymptomatic. Severe GERD can lead to potentially avoidable complications including severe oesophagitis with scarring and stricture formation, Barrett’s esophagus and adenocarcinoma.When symptoms become frequent and severe enough to require regular medication, there is a significant impact on quality of life (Ware et al 1992).(QOL)