Tatsushi Suwa, MDPhD, Kenta Kitamura, MD, Tomonori Matsumura, MD, Kazuhiro Karikomi, MD, Motoi Koyama, MDPhD, Eishi Totsuka, MDPhD, Keigo Okada, MD, Hiroyuki Suzuki, MD, Shigeru Masamura, MD. Kashiwa Kousei General Hospital
INTRODUCTION: The indication of laparoscopic anti-reflux surgery for GERD patients is difficult to be judged fairly. We have established “Reflux Test“ as the tool for the decision in the surgical indication for GERD patients.
SURGICAL INDICATION: Reflux Test: At the standing position a patient swallows 300ml barium solution. After total solution goes into stomach, a patient lies down at the flat position.
Then a patient changes the position to left lateral decubitus position, flat position, right lateral decubitus position and flat position again every 10 seconds in the order.
During this procedure, gastro-esophageal reflux was evaluated and assigned to severe, moderate and slight category. If the reflux was observed slightly up to cervical esophagus, the case was assigned to moderate category. If the reflux was observed intensely up to cervical esophagus, the position was returned to head high position for the safety and the case was assigned to severe category. The anti-reflux surgery was considered in the moderate and severe categories.
RESULTS: We have performed laparoscopic Nissen procedure in 87 cases. The mean operation time was 115 min. The outcome was assessed by Reflux Test performed on 4-5 postoperative day, and the results showed the reflux was disappeared in every cases.
Median follow-up period of this study was 38 months (7-95 months). In 13 cases (14.9%) PPI was restarted before 6 months after the anti-reflux surgery. In 25 cases (28.7%) PPI was restarted after the anti-reflux surgery during the whole follow-up period of this study.
The BMI of the patients had no relationship to the needed restart of PPI.
To evaluate the degree of esophagitis objectively before and after the anti-reflux surgery we designed “the esophagitis score”. In this scoring method, a number from 0-5 was assigned according to the degree of esophagitis along with the LA classification. The results of the study have shown that the reflux esophagitis was improved obviously after the anti-reflux surgery even in the PPI restarted group (p<0.001).
DISCUSSION: The number of GERD patients who needed anti-reflux surgery seems to be so high. To extract the patients who needed it remarkably is important. The anti-reflux surgery is most effective for the patients who really have the obvious reflux. Reflux Test is feasible because of its convenience and visual effects for the patients. The results of the laparoscopic Nissen fundoplication were good and satisfied by the patients mostly.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87574
Program Number: P406
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster