Aims. Recent studies have shown a significant effect of non acid reflux on cellular physiology in terms of development of chemical esophagitis, Barrett’s metaplasia and esophageal adenocarcinoma. The aim of this prospective study was to evaluate the effect of laparoscopic total fundoplication (LTF) in the control of non acid reflux in a group of patients with duodenogastroesophageal reflux (DGER). Methods. Patients with DGER selected to laparoscopic total fundoplication were included in a prospective controlled clinical study. Primary endpoint was the incidence of non acid reflux at 24H multichannel intraluminal impedance pH monitoring (MII-pH) at 12 months follow-up. Secondary end point was to evaluate non acid reflux morbidity. The follow-up included Gastroesophageal Reflux Health-Related Quality of Life scale (GERD-HRQOL) and Visick evaluation at 1,3 and 12 months and a complete phisiopathological evaluation including esophageal manometry, 24H MII-pH and esophagogastroendoscopy (EGDS) with biopsy at 12 months. Results. Between Jannuary 2004 and December 2008 188 patients were submitted to LTF; 172 of these (95,5%) completed the protocol: 112 acid reflux, 7 non acid reflux and 53 mixed. Bivaried analysis of preoperative and postoperative data showed in 110/112 (98%) patients with acid reflux significant improvement both in clinical and instrumental data; in patients with mixed reflux clinical and instrumental data concerning acid control are good (52/53 98%) but non acid reflux was controlled only in 29/53 (56%); in the group with non acid reflux 1 patient (14%) did well, 4/7 (57%) worsened their clinical and instrumental data and 2 were stable. Esophagitis was present in 43% (13/30) of patients with post-operative non acid reflux. Conclusions. The present study shows that LTF does not controlled satisfactory non acid reflux both in patients presenting a mixed or a pure non acid reflux. Clinical symptoms and esophagitis are frequent postoperatively in these patients.

Disappointing results of laparoscopic total fundoplication in the control of non acid reflux

REBECCHI, Fabrizio;GIACCONE, Claudio;MORINO, Mario
2011-01-01

Abstract

Aims. Recent studies have shown a significant effect of non acid reflux on cellular physiology in terms of development of chemical esophagitis, Barrett’s metaplasia and esophageal adenocarcinoma. The aim of this prospective study was to evaluate the effect of laparoscopic total fundoplication (LTF) in the control of non acid reflux in a group of patients with duodenogastroesophageal reflux (DGER). Methods. Patients with DGER selected to laparoscopic total fundoplication were included in a prospective controlled clinical study. Primary endpoint was the incidence of non acid reflux at 24H multichannel intraluminal impedance pH monitoring (MII-pH) at 12 months follow-up. Secondary end point was to evaluate non acid reflux morbidity. The follow-up included Gastroesophageal Reflux Health-Related Quality of Life scale (GERD-HRQOL) and Visick evaluation at 1,3 and 12 months and a complete phisiopathological evaluation including esophageal manometry, 24H MII-pH and esophagogastroendoscopy (EGDS) with biopsy at 12 months. Results. Between Jannuary 2004 and December 2008 188 patients were submitted to LTF; 172 of these (95,5%) completed the protocol: 112 acid reflux, 7 non acid reflux and 53 mixed. Bivaried analysis of preoperative and postoperative data showed in 110/112 (98%) patients with acid reflux significant improvement both in clinical and instrumental data; in patients with mixed reflux clinical and instrumental data concerning acid control are good (52/53 98%) but non acid reflux was controlled only in 29/53 (56%); in the group with non acid reflux 1 patient (14%) did well, 4/7 (57%) worsened their clinical and instrumental data and 2 were stable. Esophagitis was present in 43% (13/30) of patients with post-operative non acid reflux. Conclusions. The present study shows that LTF does not controlled satisfactory non acid reflux both in patients presenting a mixed or a pure non acid reflux. Clinical symptoms and esophagitis are frequent postoperatively in these patients.
18th International Congress of the EAES (European Association for Endoscopic Surgery),
Geneva
16-19 June 2010
25
S42
S42
F. Rebecchi; C. Giaccone; F. Festa; M. Morino
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/96046
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