Se Ryung Yamamoto

Comparison of laparoscopic Nissen and Toupet fundoplication using a propensity score matching analysis.

PurposeLaparoscopic fundoplication (LF) has become a standard operative procedure for GERD-related diseases in Japan, although meta-analyses have mainly evaluated findings from Western countries. The propensity score matching method was used to compare and investigate the treatment outcomes of two fundoplication procedures (the Nissen and Toupet methods).MethodsAmong 474 patients who underwent initial LF from December 1994 to April 2016, we extracted 401 cases (Nissen: 92 cases, Toupet: 309 cases), excluding 73 patients in whom follow-up was insufficient. We then matched 126 of these patients (63 per group).ResultsThe esophageal acid reflux time (%) was 12.2:2.8, being higher in the Nissen group than in the Toupet group (p < 0.001). Regarding the surgical outcome, the amount of bleeding was higher in the Nissen group (p = 0.001), and the number of hospitalization days following surgery was longer (p = 0.003). Furthermore, a significantly rate of postoperative difficulty in swallowing (%) was observed in the Nissen group, at 13:0 (p = 0.004). The recurrence rate (%) was 8:3, with no difference between the two groups (p = 0.243).ConclusionsAlthough there was no marked difference in the recurrence rate between the two procedures, postoperative dysphagia was observed at a higher frequency with the Nissen method than the Toupet method.

A novel laparoscopic approach for severe esophageal stenosis due to reflux esophagitis: how to do it.

We herein report our technique for laparoscopic esophageal myotomy combined with Collis gastroplasty and Nissen fundoplication for severe esophageal stenosis. Our patient had experienced vomiting since childhood, and his dysphagia had gradually worsened. He was referred to our department for surgery because of resistance to pneumatic dilation. He was diagnosed with a short esophagus based on the findings of a preoperative upper gastrointestinal series and GI endoscopy. After exposing the abdominal esophagus, esophageal myotomy around the esophago-gastric junction (EGJ) was undertaken to introduce an esophageal bougie into the stomach. Then, stapled wedge gastroplasty was performed, and a short and loose Nissen fundoplication was performed. In addition, the bulging mucosa after myotomy was patched using the Dor method. The patient’s postoperative course was uneventful. Most patients with esophageal stricture require subtotal esophagectomy. Laparoscopic surgery for patients with benign esophageal stricture refractory to repeated pneumatic dilation is challenging. However, our current procedure might abrogate the need for invasive esophagectomy for the surgical management of severe esophageal stenosis.

The outcomes of 400 laparoscopic Heller-Dor operations (LHD) for esophageal achalasia

METHODS: Mean age was 44.6 (9-83) years, 189 (47%) were women. These patients were divided into 4 groups: very early, early, mid, and late groups. The clinical pathway was introduced from August 2008 (62nd case). Six and 20 patients underwent RPS in both mid and late group, respectively. Their clinical data were collected in a prospectively fashion and retrospectively reviewed. Their characteristics, preoperative clinical conditions, and the therapeutic outcomes of LHD were assessed in terms of gender, age, length of symptoms, morphologic type, the maximum horizontal diameter of the esophagus (Grade I [<3.5 cm], Grade II [ 3.5 cm but <6.0 cm], and Grade III [ 6.0 cm]), operation time, blood loss, perioperative complications, time to start oral intake (TSOI), postoperative hospital stay (POHS), and the incidence of postoperative reflux esophagitis (PORE).