• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Revision of Failed Traditional Fundoplication Using Esophyx Transoral Fundoplication

Reginald C. W Bell, MD, Katherine D. Freeman, NP, Rachel Hufford, RN. SurgOne P.C.

 

Introduction:
Recurrent gastroesophageal reflux disease (GERD) after traditional fundoplication occurs due to loosening of the fundoplication without a weakening of the hiatal closure in 10-30% of cases. Although laparoscopic revision of failed fundoplication has been reported to be effective and safe in specialty centers, the surgery is tedious and involves risk of gastric, esophageal, and vagal nerve injury that is higher than with primary fundoplication. The EsophyX device offers an alternative, less invasive, transoral approach to revision of loose fundoplication with avoidance of the dissection and risks associated with the conventional revision.
Methods:
Patients who had previously undergone a traditional Nissen or Toupet fundoplication and had symptomatic and objective evidence of recurrent GERD due to loosening of the wrap without any evidence of loosening of the hiatal closure, were offered the EsophyX TIF procedure for revision. This study was approved by Western Institutional Review Board. The subjective outcomes were evaluated with GERD Health Related Quality of Life (GERD-HRQL) and Reflux Symptom Index (RSI) questionnaires. Secondarily, normalization of esophageal acid exposure and the number of reflux episodes measured objectively by ambulatory pH tests and proton pump inhibitors (PPIs) use after revision were evaluated.
Results:
Eleven patients underwent revision of a prior Nissen fundoplication using EsophyX; 9 completed follow-up and were included in this study. One patient underwent unsuccessful EsophyX revision of a Toupet and did not participate in follow-up. Median age was 60 (28-75) years, 4 were female, and median BMI was 24 (17-41) kg/m2. These 9 patients presented with typical and/or atypical medically refractory GERD symptoms at a median of 3 (1-15) years after primary fundoplication. All had objective evidence of GERD by endoscopy, barium esophagram, or ambulatory reflux testing. Endoscopy confirmed loosening of the fundoplication without evidence of transthoracic wrap migration, paraesophageal hernia, or > 2cm axial herniation. All patients successfully completed the TIF procedure with median operative time of 71 (47-90) minutes and were discharged within 24 hours. One patient early in our experience developed a postoperative bleed requiring transfusion and led to technique changes that have reduced this risk. At a median of 8 (5-19) month follow up, 7 of 9 patients completed GERD-HRQL and RSI questionnaires and 8 of 9 completed pH tests. Mean GERD-HRQL score improved significantly from 14.1 (2.5) preoperatively to 3.7 (1.2) post TIF (p=0.003). Mean RSI score improved >50% in 4 of 6 patients. Seven patients had impedance/pH or 48-h telemetry capsule pH testing off acid-suppressive medication preoperatively and postoperatively. In these 7 patients mean % time with pH < 4 improved from 9.8% (21%-4.8%) to 3.6% (13.4%-0.1%); p=0.09, Mann-Whitney U. Number of reflux episodes per 24-h decreased from 62 (105-21) to 16 (26-0); p=0.004, Mann-Whitney U. Only one patient remained on PPI therapy after TIF and that despite a pH test demonstrating 0.5% esophageal acid exposure. No denovo dysphagia or bloating was reported.
Conclusions:
Transoral revision of failed fundoplication without herniation using EsophyX is technically feasible. It results in symptomatic and objective improvement of GERD without the risks of laparoscopic dissection.
 


Session Number: SS18 – Foregut
Program Number: S096

1,280

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2012 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons