Laparoscopic Antireflux Surgery 9811971722, 9789811971723

Table of contents :
Acknowledgements
Contents
1: The Chronicle of Antireflux Surgery
1.1 Historical Trends of Antireflux Surgery
1.1.1 Initiation of Antireflux Surgery
1.2 Concept of His Angle
1.3 Esophageal Lengthening Procedure
1.4 The Advent of Fundoplication
1.5 Modern Alternative Efforts to Improve Antireflux Surgery
1.6 Conclusion
References
2: GERD Pathogenesis and Essential Anatomic Knowledge for Antireflux Surgery
2.1 Definition of GERD
2.2 Anatomic Structure of the Gastroesophageal Junction and Pathogenesis of GERD
2.2.1 Lower Esophageal Sphincter
2.2.2 Esophageal Hiatus
2.2.3 Other Factors that May Aggravate GERD Symptoms
2.2.4 A Scenario in the Development of GERD: A Vicious Cycle
2.3 Role of Antireflux Surgery in Restoration of Normal Antireflux Valve Mechanism
2.3.1 Strengthening of LES: Fundoplication
2.3.2 Restoration of Normal GEJ Anatomy: Cruroplasty
2.3.3 Prevention of Recurrence of Hiatal Hernia
2.3.4 Prevention of Adverse Symptoms After ARS
2.3.5 Relationship Between TLESR and ARS
References
3: Clinical Manifestations and Surgical Indications of Gastroesophageal Reflux Disease
3.1 Clinical Manifestation of Gastroesophageal Reflux Disease
3.1.1 Esophageal Syndromes
3.1.1.1 Typical Reflux Syndrome
3.1.1.2 Reflux Chest Pain Syndrome
3.1.1.3 Syndromes with Esophageal Injury
3.1.2 Extraesophageal Syndromes
3.2 Surgical Indications and Predisposing Factors to Predict the Outcome of ARS
References
4: Anti-reflux Surgery to Extra-esophageal Manifestations of GERD
4.1 Extra-esophageal Manifestation of GERD
4.2 Laryngopharyngeal Reflux
4.3 Pathophysiology
4.4 Diagnosis
4.5 Hypopharyngeal Multichannel Intraluminal Impedance
4.6 Anti-reflux Surgery to Extra-esophageal Manifestations
References
5: Diagnostic Tests and Interpretations Before Anti-reflux Surgery
5.1 Introduction
5.2 Endoscopic Findings
5.3 24-Hour Esophageal pH Test
5.3.1 Equipment
5.3.1.1 pH Electrodes
5.3.1.2 Data Recorder
5.3.2 Technique
5.3.2.1 Preparation
5.3.2.2 Calibration of Electrodes
5.3.2.3 Location of Electrodes
5.3.3 Interpretation
5.3.3.1 Variables
5.3.3.2 Association with Symptoms
5.3.4 Clinical Application
5.3.5 Limitations
5.4 Esophageal Impedance Test
5.4.1 Fundamental Principles of Impedance Test
5.5 Esophageal Impedance-pH Test
5.5.1 Equipment and Technique
5.5.2 Data Analysis
5.5.2.1 Normal Value of Impedance-pH Test
5.5.2.2 Interpretation
5.5.3 Clinical Application
5.6 Esophageal Manometry
5.6.1 Indication
5.6.2 Equipment
5.6.3 Technique
5.6.3.1 Preparation Before Examination
5.6.3.2 Equipment
5.6.3.3 Examination
5.6.3.4 Recording Test Results
General Information
Lower Esophageal Sphincter
Esophageal Body
Upper esophageal Sphincter
Interpretation of Results
5.6.4 Interpretation
5.6.4.1 Manometric Finding of Normal Esophagus
5.6.4.2 Upper Esophageal Sphincter
5.6.4.3 Esophageal Body
5.6.4.4 Lower Esophageal Sphincter
Classic Achalasia
Atypical Disorders of LES Relaxation
Diffuse Esophageal Spasm
Nutcracker Esophagus
Isolated Hypotensive LES
Esophageal Hypocontraction
5.7 Esophageal Impedance-Manometry Test
5.7.1 Equipment and Technique
5.7.2 Analyzing and Interpretation
5.7.2.1 Definition of Impedance Indicator
5.7.2.2 Interpretation
5.7.3 Clinical Applications and Limits
5.8 Conclusion
References
6: Various Techniques of Anti-reflux Treatment
6.1 Introduction
6.2 Epidemiology
6.3 Clinical Features
6.4 Pathogenesis
6.5 Diagnosis
6.6 Investigational Tests
6.7 Treatment
6.7.1 Lifestyle Modification
6.7.2 Medical Treatment
6.7.3 Endoscopic Options
6.7.4 Surgical Options
6.7.5 Operative Techniques
6.8 Complete Fundoplication
6.9 Partial Fundoplication
6.9.1 Long-Term Efficacy
6.10 Conclusions
References
7: Postoperative Clinical Pathway After Anti-reflux Surgery
7.1 Definition of a Clinical Pathway
7.2 Clinical Pathway for Anti-reflux Surgery
7.3 Example of a CP After ARS
7.4 Pre-operation Day
7.5 Operation Day
7.6 Post-operation Day 1–2
7.7 Post-operation Day Three (Discharge Date)
References
8: Complications After Antireflux Surgery (ARS) and Managements
8.1 Introduction
8.2 Acute Technical Complications After Antireflux Surgery
8.3 Functional Complications Following Antireflux Surgery
8.4 Summary
References
9: Long-Term Outcomes and Cost-Effectiveness of Anti-reflux Surgery
9.1 Long-Term Outcomes of Laparoscopic Anti-reflux Surgery
9.1.1 Clinical Outcomes of Laparoscopic Anti-reflux Surgery
9.1.2 Comparison of Total Versus Partial Fundoplication
9.1.2.1 Total Versus Toupet
9.1.2.2 Total Versus Dor
9.2 Cost-Effectiveness of Laparoscopic Fundoplication Versus Medical Treatment
9.2.1 Cost-Effectiveness Analysis in the Field of Medicine
9.2.2 Cost-Effectiveness Study of Anti-reflux Surgery
References
10: Failure and Revision of Antireflux Surgery
10.1 Introduction
10.2 Failure of ARS
10.3 Risk Factors for Failure of ARS
10.4 Evaluation of Patients with Persistent or Recurrent Symptoms After ARS
10.4.1 Upper Endoscopy
10.4.2 Barium Esophogram
10.4.3 pH Monitoring
10.4.4 Esophageal Manometry
10.5 Revisional Surgery
10.5.1 Operative Technique
10.5.2 Challenging Hiatal Closure Strategies
10.5.3 Adjunctive Procedure: EndoFLIP
10.5.4 Complications and Outcomes
10.5.5 Roux-En-Y Reconstruction
10.6 Summary
References
11: Anti-reflux Surgery During Specific Situations: Achalasia, Para-esophageal Large Hiatal Hernia
11.1 Anti-reflux Surgery for Achalasia
11.2 Anti-reflux Surgery for Large Paraesophageal Hernia
References
12: Reflux After Bariatric Surgery
12.1 GERD and Obesity
12.2 Reflux After Sleeve Gastrectomy
12.3 Reflux After Gastric Bypass
12.4 Reflux After Adjustable Gastric Band
12.5 Reflux After Mini-gastric Bypass/One-Anastomosis Gastric Bypass
12.6 Conclusions
References
13: Emerging Surgical Options
13.1 Introduction
13.2 LINX® Reflux Management System
13.2.1 Cross Section of the LINX Device in Open and Closed Positions
13.2.2 Safety and Efficacy
13.3 Stretta® Procedure
13.3.1 Remodeling of the Musculature by Stretta Therapy
13.3.1.1 Safety and Efficacy
13.4 Transoral Incisionless Fundoplication
13.4.1 Safety and Efficacy
13.5 Electrical Stimulation of Lower Esophageal Sphincter
13.6 EndoFlip Impedance Planimetry System
13.7 Summary
References

Citation preview

Laparoscopic Antireflux Surgery Sungsoo Park Miguel Burch Joong-Min Park Editors

123

Laparoscopic Antireflux Surgery

Sungsoo Park  •  Miguel Burch Joong-Min Park Editors

Laparoscopic Antireflux Surgery

Editors Sungsoo Park Department of Surgery Korea University Medical Center Seoul, Korea (Republic of)

Miguel Burch Department of Surgery Cedars Sinai Medical Center Los Angeles, CA, USA

Joong-Min Park Department of Surgery Chung-Ang University Gwangmyeong Hospital Gwangmyeong, Korea (Republic of)

ISBN 978-981-19-7172-3    ISBN 978-981-19-7173-0 (eBook) https://doi.org/10.1007/978-981-19-7173-0 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Acknowledgements

Although our names appear as the book authors, this book has been the result of the work of a large team who not only contributed some of the individual chapters but helped with their editing, organization and checked their facts and figures. We are naming them below: Ahmad Salem Nammour Alromi, Jordanian Board of General Surgery, Ministry of Health Jordan, Jordan—contributed in checking of spelling errors, figures, tables and references in whole book and literature search Without him, we would not have been able to complete this large book and we are deeply grateful for all the help they have given us.

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Contents

1 The  Chronicle of Antireflux Surgery���������������������������������������������   1 Sang-Yong Son, Shin-Hoo Park, and Sang-Uk Han 2 GERD  Pathogenesis and Essential Anatomic Knowledge for Antireflux Surgery ������������������������������������������������   7 Jin-Jo Kim 3 Clinical  Manifestations and Surgical Indications of Gastroesophageal Reflux Disease ��������������������������������������������������  15 Joong-Min Park and Sungsoo Park 4 A  nti-reflux Surgery to Extra-­esophageal Manifestations of GERD ����������������������������������������������������������������  23 Yosuke Seki 5 Diagnostic  Tests and Interpretations Before Anti-­reflux Surgery��������������������������������������������������������������������������  31 Beom Jin Kim 6 Various Techniques of Anti-reflux Treatment ������������������������������  51 George Tadros, Sinal Patel, Emanuele Lo Menzo, Samuel Szomstein, and Raul Rosenthal 7 Postoperative  Clinical Pathway After Anti-reflux Surgery����������  63 Dong-Wook Kim and Jeong Goo Kim 8 C  omplications After Antireflux Surgery (ARS) and Managements����������������������������������������������������������������������������  69 Kyo Young Song 9 L  ong-Term Outcomes and Cost-­Effectiveness of Anti-reflux Surgery����������������������������������������������������������������������  75 Kyung Won Seo 10 Failure  and Revision of Antireflux Surgery����������������������������������  79 Joshua Tseng and Miguel Burch 11 Anti-reflux  Surgery During Specific Situations: Achalasia, Para-­esophageal Large Hiatal Hernia������������������������  87 Won Jun Seo and Jong-Han Kim

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12 Reflux After Bariatric Surgery ������������������������������������������������������  93 Allison M. Barrett 13 Emerging Surgical Options ������������������������������������������������������������ 101 Joshua Tseng and Miguel Burch

Contents

1

The Chronicle of Antireflux Surgery Sang-Yong Son, Shin-Hoo Park, and Sang-Uk Han

Abstract

Antireflux surgery is an effective treatment option for patients with gastroesophageal reflux disease (GERD) who respond inadequately to medical therapy, want to avoid lifelong medication use, or have significant complications such as Barrett’s esophagus or stricture due to acid reflux. Antireflux surgery is a commonly performed procedure in the United States. The number of antireflux surgeries increased from 9173  in 1993 to 32,980  in 2000 but steadily declined to 19,668 in 2006, possibly due to the development of proton pump inhibitor (PPI) therapy and the popularity of laparoscopic bariatric surgery (Wang et al. Dis Esophagus. 24:215– 23, 2011). According to the National Inpatient Sample database of the United States, 83.1%, 11.6%, and 5.3% of patients underwent antireflux surgery in high-volume centers (>25 operations/year), intermediate-volume hospitals (10–25 operations/year), and low-volume hospitals (  4/day for 24 h (Fig. 4.3).

Y. Seki

28

4.6 Anti-reflux Surgery to Extra-­ esophageal Manifestations It is well established that patients with typical symptoms have better outcomes after anti-reflux surgery (ARS) than those with atypical symptoms. This seems to be true at both short- and long-term follow-up. At 1-year follow-up, 99% of patients with typical symptoms demonstrated improvement, as compared to 93% of patients with atypical symptoms. Complete resolution is seen in 87% of patients with typical symptoms, as compared to only 43% of those patients with atypical symptoms [22]. At 10-year follow-up of the same group, 85% of patients with typical symptoms had a successful outcome compared with 41% of patients with atypical symptoms [23]. Specifically, cough has been shown to significantly improve following laparoscopic anti-­ reflux surgery with cure rates of 53% [24], short-term improvement rates from 69% to100% [25, 26], and long-term improvement rates of 71% [26]. Hoarseness [27–29], sore throat [27, 28], and bronchitis [28, 29] have also been reported significantly improved following surgery. Improvement has also been reported for pulmonary symptoms [23, 30], aspiration [29, 31], and wheezing [27, 31] symptoms. While some reports have shown improvement in asthma [25, 28] and laryngitis [28] following anti-reflux surgery, others have reported no benefit [23, 29, 32]. More recently, to improve the sensitivity of LPR diagnosis and better elucidate those who will respond to ARS, Hoppo et  al. performed HMII to patients with chronic cough, which was defined as persistent cough (≥8  weeks) of unknown cause. Of the 49 patients identified as having chronic cough, 23 of 44 patients (52%) had objective findings of GERD, such as esophagitis. Abnormal proximal exposure (APE) was discovered in 36 of the 49 patients (73%). Of 16 patients with APE who subsequently underwent ARS, 13 patients (81%) had resolution of cough and 3 patients (19%) had significant improvement at a median follow-up of 4.6 months [33]. Suzuki et  al. performed HMII to 52 Japanese patients with LPR symptoms such as chronic

Fig. 4.4  Comparison of the RSI (reflux symptom index) between pre- and post-ARS in the patients with LPR diagnosed as APE (abnormal proximal exposure) by HMII. Mean RSI was significantly lower after ARS than before ARS (22.9 ± 10.0 vs. 6.8 ± 6.8, p