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Fundoplication
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Douglas C. Barnhart, Robert A. Cina
Nissen fundoplication is indicated in infants and children who have complications of gastroesophageal reflux which are not adequately controlled with dietary modification and medical therapy. This principle can be difficult to operationalize because many symptoms attributed to gastroesophageal reflux can overlap with concomitant disease such as reactive airway disease, failure to thrive, feeding difficulties, irritability-related developmental delay, and cerebral palsy. Given these complexities, the decision about proceeding with fundoplication should be based on a detailed history with a particular emphasis on feeding issues and targeted diagnostic testing and should culminate with shared decision-making with the parents and other medical providers.
Dyspepsia
Published in Andrew Stevens, James Raftery, Jonathan Mant, Sue Simpson, Health Care Needs Assessment, 2018
Brendan C. Delaney, Paul Moayyedi
The Nissen fundoplication and the Hill posterior gastropexy are the two commonest anti-reflux procedures. The Nissen fundoplication involves mobilisation of the fundus of the stomach that is then wrapped around the lower oesophagus. The gastro-oesophageal junction is sutured to the median arcuate ligament in a Hill posterior gastropexy and the stomach is also held in position by a partial anterior fundic wrap. Surgery is associated with a 1% mortality and a 2–8% morbidity, consisting mainly of gas-bloat syndrome and dysphagia. The short-term success rate of surgery in carefully selected cases is 85% but 10% have a recurrence of symptoms during follow-up.74 Laparoscopic Nissen fundoplication may make surgery more attractive although one randomised controlled trial suggested it was associated with more morbidity than the open procedure.75
Management of idiopathic pulmonary fibrosis
Published in Muhunthan Thillai, David R Moller, Keith C Meyer, Clinical Handbook of Interstitial Lung Disease, 2017
Damian AD Bruce-Hickman, Helen Garthwaite, Melissa Heightman, Bibek Gooptu
Other strategies to manage GERD beyond use of anti-acid therapies remain important, such as lifestyle modifications and smoking cessation. The role of prokinetics, such as domperidone and metoclopramide, is unclear. Surgical intervention, such as Nissen fundoplication, is effective in treating GERD and has shown benefits in retrospective analysis in IPF patients (94). Further studies are ongoing to assess the role of such surgery.
The safety and efficacy of peroral endoscopic cardial constriction in gastroesophageal reflux disease
Published in Scandinavian Journal of Gastroenterology, 2022
Wenxi Jiang, Guangwu Chen, Caijuan Dong, Shefeng Zhu, Jiaqi Pan, Zhaoxue Liu, Meng Li, Chaohui Yu, Zhe Shen
Nissen fundoplication is widely regarded as the gold standard among the anti-reflux procedures, especially for patients with severe reflux esophagitis (LA grade C or D) and large hiatal hernias [22]. A study showed that 91% of patients had relief of reflux symptoms after Nissen fundoplication [32]. However, its perioperative mortality rates was reported to be 0.2% and prolonged structural complications occurred in 30% of cases [7]. Although PECC was not as superior as Nissen fundoplication, it was a minimally invasive alternative to surgery for patients who do not have severe reflux esophagitis (LA grade C or D) or hiatal hernias >2 cm with fewer postoperative complications and cheaper medical expenses.
A case-control comparative study between Toupet-Sleeve and conventional sleeve gastrectomy in patients with preoperative gastroesophageal reflux
Published in Acta Chirurgica Belgica, 2023
Philippe Hauters, Etienne van Vyve, Iulia Stefanescu, Charles-Edouard Gielen, Sylvie Nachtergaele, Manon Mahaudens
In a first attempt to improve the control of GERD after SG, several authors proposed simultaneous SG and hiatus hernia repair. In most studies, the technique consisted of reduction of HH when present and routine posterior crural approximation with nonabsorbable sutures [20]. Despite early promising results [20], three recent comparative trials clearly revealed that routine hiatus hernia repair at the time of SG does not significantly reduce the incidence of postoperative reflux symptoms compared with SG alone [21–23]. More recently, the team of Montpellier proposed to combine anti-reflux Nissen fundoplication with SG [6] and called that new operation Nissen-Sleeve (N-Sleeve). That new concept was a source of several concerns. The first one was the efficiency of the anti-reflux wrap on GERD symptoms. Indeed, it has been well documented that the rate of reflux symptoms recurrence after fundoplication was higher in obese compared to non-obese patients [24]. Also, one may wonder if a Nissen fundoplication will be as effective after the removal of two-thirds of the stomach than with a full stomach in place. Another potential drawback of this technique was to leave an excessive gastric fundus in place, which may dilate in long term with the potential risk of long-term weight regain. It was also suggested that adding a fundoplication may potentially mitigate the ghrelin reduction or other metabolic effects. There are currently only 7 series reporting the outcomes of SG combined to a different type of anti-reflux wrap [6,25–29]. Those studies included a limited number of patients and the follow-up was generally limited to 1 year. Consequently, there are still a lot of unanswered questions about that new concept.
Gastroesophageal reflux disease (GERD) in children
Published in Paediatrics and International Child Health, 2019
Nissen fundoplication (open or laparoscopic) is indicated for children in whom optimal medical therapy has failed, who are dependent on medical therapy for a long period or who have life-threatening complications of GERD. Neurologically impaired children, a group who require surgery the most often, are prone to develop surgery-related complications and surgical failure. Surgery fails in almost two thirds of neurologically impaired children and one third of otherwise healthy children and they require long-term medical treatment [1]. Early fundoplication in infancy has a higher failure rate than in late childhood [1,18].