Abstract
Purpose
Surgical treatments for nonerosive gastroesophageal reflux disease (NERD) have not been investigated sufficiently. We examined the results of laparoscopic fundoplication for patients with NERD.
Methods
We performed laparoscopic fundoplication for NERD in 22 patients. The severity of esophageal hiatal hernia, morphology of the cardiac orifice, and results of 24-hour continuous esophageal and gastric pH were evaluated. We used a four-point scale for the improvement rating of postoperative symptoms.
Results
There were 20 patients (91%) with a sliding hiatal hernia, and 21 patients (95%) with a loose cardiac orifice. Seven patients had acid reflux with 4.0% or higher esophageal fraction of time pH below 4. The surgical techniques used were Nissen fundoplication in 10 patients and Toupet fundoplication in 12 patients. Improvement of postoperative heartburn was rated as excellent in 16 patients, good in 5, and fair in 1. The overall efficacy rating was 95%, and discontinuation of proton pump inhibitor (PPI) was possible in 21 patients.
Conclusion
Our results of performing laparoscopic fundoplication in patients with NERD were excellent. Even if abnormal acid reflux cannot be confirmed preoperatively, sufficient therapeutic efficacy can be expected for patients with esophageal hiatal hernia or a loose cardiac orifice.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
PR Allison (1951) ArticleTitleReflux esophagitis, sliding hiatal hernia, and the anatomy of repair Surg Gynecol Obstet 92 419–31 Occurrence Handle14835197 Occurrence Handle1:STN:280:DyaG3M%2FmsVOntQ%3D%3D
R Nissen (1961) ArticleTitleGastropexy and fundoplication in surgical treatment of hiatal hernia Am J Dig Dis 6 954–61 Occurrence Handle14480031 Occurrence Handle1:STN:280:DyaF38%2FotFGgtA%3D%3D Occurrence Handle10.1007/BF02231426
LD Hill (1967) ArticleTitleAn effective operation for hiatal hernia: an eight year appraisal Ann Surg 166 681–92 Occurrence Handle6061546 Occurrence Handle1:STN:280:DyaF1c%2FlsFSquw%3D%3D Occurrence Handle10.1097/00000658-196710000-00015
AE Baue RHR Belsey (1967) ArticleTitleThe treatment of sliding hiatus hernia and reflux esophagitis by the Mark IV technique Surgery 62 396–404
PE Donahue S Samelson LM Nyhus CT Bombeck (1985) ArticleTitleThe floppy Nissen fundoplication. Effective long-term control of pathologic reflux Arch Surg 120 663–8 Occurrence Handle4004552 Occurrence Handle1:STN:280:DyaL2M3isVyqtA%3D%3D
DB Skinner RHR Belsey PS Russell (1967) ArticleTitleSurgical management of esophageal reflux and hiatus hernia J Thorac Cardiovasc Surg 53 33–54 Occurrence Handle5333620 Occurrence Handle1:STN:280:DyaF2s%2Flslygsg%3D%3D
RM Bremner TR DeMeester PF Crookes M Costantini SF Hoeft JH Peters et al. (1994) ArticleTitleThe effect of symptoms and nonspecific motility abnormalities on outcomes of surgical therapy for gastroesophageal reflux disease J Thorac Cardiovasc Surg 107 1244–50 Occurrence Handle8176967 Occurrence Handle1:STN:280:DyaK2c3jtFyhtw%3D%3D
G Vollan L Stangeland JA Søreide CW Janssen K Svanes (1992) ArticleTitleLong term results after Nissen fundoplication and Belsey Mark IV operation in patients with reflux oesophagitis and stricture Eur J Surg 158 357–60 Occurrence Handle1356468 Occurrence Handle1:STN:280:DyaK3s%2FgtlKkug%3D%3D
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R. Laparoscopic Nissen fundoplication. Preliminary report. Surg Laparosc Endosc 1991;1:138–43
G Perdikis RA Hinder GJ Wetscher (1996) ArticleTitleLaparoscopic Nissen fundoplication-technique and results Dis Esophagus 9 272–7
M O'Reilly SG Mullins WB Saya SE Pinto PT Falkner (1996) ArticleTitleLaparoscopic posterior partial fundoplication: analysis of 100 consecutive cases J Laparoendosc Surg 6 141–50 Occurrence Handle8807514
GB Cadiere J Himpens A Rajan V Muls JC Lemper J Bruyns et al. (1997) ArticleTitleLaparoscopic Nissen fundoplication: laparoscopic dissection technique and results Hepatogastroenterology 44 4–10 Occurrence Handle9058110 Occurrence Handle1:STN:280:DyaK2s3htFWisA%3D%3D
MS Dassinger A Torquati HL Houston MD Holzman KW Sharp WO Richards (2004) ArticleTitleLaparoscopic fundoplication: 5-year follow-up Am Surg 70 691–5 Occurrence Handle15328802 Occurrence Handle1:STN:280:DC%2BD2cvitlersQ%3D%3D
G Nilsson J Wenner S Larsson F Johnsson (2004) ArticleTitleRandomized clinical trial of laparoscopic versus open fundoplication for gastro-oesophageal reflux Br J Surg 91 552–9 Occurrence Handle15122604 Occurrence Handle1:STN:280:DC%2BD2c3it1agtQ%3D%3D Occurrence Handle10.1002/bjs.4483
M Wienbeck J Barnert (1989) ArticleTitleEpidemiology of reflux disease and reflux esophagitis Scand J Gastroenterol 24 IssueIDSuppl 156 7–13
SJ Spechler (1992) ArticleTitleEpidemiology and natural history of gastro-oesophageal reflux: incidence and precipitating factors Digestion 51 IssueIDSuppl 1 24–9 Occurrence Handle1397743 Occurrence Handle10.1159/000200911
R Carlsson J Dent R Watts S Riley R Sheikh J Hatlebakk et al. (1998) ArticleTitleGastro-oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole Eur J Gastroenterol 10 119–24 Occurrence Handle1:STN:280:DyaK1c3ktFWnsA%3D%3D Occurrence Handle10.1097/00042737-199802000-00004
JE Richter D Peura SB Benjamin Bo Joelsson J Whipple (2000) ArticleTitleEfficacy of omeprazole for the treatment of symptomatic acid reflux disease without esophagitis Arch Intern Med 160 1810–6 Occurrence Handle10871975 Occurrence Handle1:CAS:528:DC%2BD3cXltFWisLo%3D Occurrence Handle10.1001/archinte.160.12.1810
WD Chey (2004) ArticleTitleEndoscopy-negative reflux disease: concepts and clinical practice Am J Med 117 IssueIDSuppl 5A 36S–43S Occurrence Handle15478851
I Wiklund (2001) ArticleTitleQuality of life in patients with gastroesophageal reflux disease Am J Gastroenterol 96 IssueIDSuppl S46–53 Occurrence Handle11510771 Occurrence Handle1:STN:280:DC%2BD3Mvms1aksQ%3D%3D Occurrence Handle10.1016/S0002-9270(01)02591-6
AJPM Smout (1997) ArticleTitleEndoscopy-negative acid reflux disease Aliment Pharmacol Ther 11 IssueIDSuppl 2 81–5
T Lind T Havelund R Carlsson O Anker-Hansen H Glise H Hernqvist et al. (1997) ArticleTitleHeartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response Scand J Gastroenterol 32 974–9 Occurrence Handle9361168 Occurrence Handle1:CAS:528:DyaK2sXmslOrt78%3D Occurrence Handle10.3109/00365529709011212
TL Venables RD Newland AC Patel J Hole C Wilcock ML Turbitt (1997) ArticleTitleOmeprazole 10 milligrams once daily, omeprazole 20 milligrams once daily, or ranitidine 150 milligrams twice daily, evaluated as initial therapy for the relief of symptoms of gastro-oesophageal reflux disease in general practice Scand J Gastroenterol 32 965–73 Occurrence Handle9361167 Occurrence Handle1:CAS:528:DyaK2sXmslOrt74%3D
KD Bardhan (2003) ArticleTitleIntermittent and on-demand use of proton pump inhibitors in the management of symptomatic gastroesophageal reflux disease Am J Gastroenterol 98 IssueIDSuppl S40–8 Occurrence Handle12644030 Occurrence Handle10.1016/S0002-9270(03)00014-5
J Bancewicz HR Matthews T O'Hanrahan I Adams (1990) A comparison of surgically treated reflux patients in two surgical centers AG Little MK Ferguson DB Skinner (Eds) Diseases of the esophagus Mount Kisco New York 177–80
T Ismail J Bancewicz J Barlow (1995) ArticleTitleYield pressure, anatomy of the cardia and gastro-oesophageal reflux Br J Surg 82 943–7 Occurrence Handle7648116 Occurrence Handle1:STN:280:DyaK2Mzns1Wmuw%3D%3D
LF Johnson TR DeMeester (1974) ArticleTitleTwenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux Am J Gastroenterol 62 325–32 Occurrence Handle4432845 Occurrence Handle1:STN:280:DyaE2M%2Flt1WmtQ%3D%3D
R Fass (2003) ArticleTitleEpidemiology and pathophysiology of symptomatic gastroesophageal reflux disease Am J Gastroenterol 98 IssueIDSuppl S2–7 Occurrence Handle12644025 Occurrence Handle10.1016/S0002-9270(03)00009-1
BE Schenk EJ Kuipers EC Klinkenberg-Knol HP Festen EH Jansen HA Tuynman et al. (1997) ArticleTitleOmeprazole as a diagnostic tool in gastroesophageal reflux disease Am J Gastroenterol 92 1997–2000 Occurrence Handle9362179 Occurrence Handle1:STN:280:DyaK1c%2Fis1GjsA%3D%3D
JE Richter DR Campbell PJ Kahrilas B Huang C Fludas (2000) ArticleTitleLansoprazole compared with ranitidine for the treatment of nonerosive gastroesophageal reflux disease Arch Intern Med 160 1803–9 Occurrence Handle10871974 Occurrence Handle1:CAS:528:DC%2BD3cXltFWisL0%3D Occurrence Handle10.1001/archinte.160.12.1803
LM Bernstein LA Backer (1958) ArticleTitleA clinical test for esophagitis Gastroenterology 34 760–81 Occurrence Handle13538145 Occurrence Handle1:STN:280:DyaG1c%2FotFSqsg%3D%3D
H Miwa T Minoo M Hojo R Yaginuma A Nagahara M Kawabe et al. (2004) ArticleTitleOesophageal hypersensitivity in Japanese patients with nonerosive gastroesophageal reflux diseases Aliment Pharmacol Ther 20 IssueIDSuppl 1 S112–7 Occurrence Handle10.1111/j.1365-2036.2004.01990.x
D Sifrim R Holloway J Silny Z Xin J Tack A Lerut et al. (2001) ArticleTitleAcid, nonacid, and gas reflux in patients with gastroesophageal reflux disease during ambulatory 24-hour pH-impedance recordings Gastroenterology 120 1588–98 Occurrence Handle11375941 Occurrence Handle1:STN:280:DC%2BD3M3ps1Giuw%3D%3D Occurrence Handle10.1053/gast.2001.24841
YS Khajanchee D Hong PD Hansen LL Swanstrom (2004) ArticleTitleOutcomes of antireflux surgery in patients with normal preoperative 24-hour pH test results Am J Surg 187 599–603 Occurrence Handle15135673 Occurrence Handle10.1016/j.amjsurg.2004.01.010
RCW Bell P Hanna S Brubaker (2001) ArticleTitleLaparoscopic fundoplication for symptomatic but physiological gastroesophageal reflux J Gastrointest Surg 5 462–7 Occurrence Handle11985996 Occurrence Handle1:STN:280:DC%2BD383ksF2mtg%3D%3D Occurrence Handle10.1016/S1091-255X(01)80083-4
T Bammer M Freeman A Sbabriari RA Hinder KR DeVault SR Acbem (2002) ArticleTitleOutcome of laparoscopic antireflux surgery in patients with nonerosive reflux disease J Gastrointest Surg 6 730–7 Occurrence Handle12399063 Occurrence Handle10.1016/S1091-255X(02)00042-2
M Frazzoni ED Micheli P Zentilin V Savarino (2004) ArticleTitlePathophysiological characteristics of patients with nonerosive reflux disease differ from those of patients with functional heartburn Aliment Pharmacol Ther 20 81–8 Occurrence Handle15225174 Occurrence Handle1:STN:280:DC%2BD2czitlGgtw%3D%3D Occurrence Handle10.1111/j.1365-2036.2004.01998.x
AJ Cameron (1999) ArticleTitleBarrett's esophagus: prevalence and size of hiatal hernia Am J Gastroenterol 94 2054–9 Occurrence Handle10445527 Occurrence Handle1:STN:280:DyaK1Mznt1Kquw%3D%3D Occurrence Handle10.1111/j.1572-0241.1999.01277.x
RA Wright Hirwitz (1979) ArticleTitleRelationship of hiatal hernia to endoscopically proved reflux esophagitis Dig Dis Sci 24 311–33 Occurrence Handle456217 Occurrence Handle1:STN:280:DyaE1M3htlSmtQ%3D%3D Occurrence Handle10.1007/BF01296546
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Omura, N., Kashiwagi, H., Yano, F. et al. Therapeutic Effects of Laparoscopic Fundoplication for Nonerosive Gastroesophageal Reflux Disease. Surg Today 36, 954–960 (2006). https://doi.org/10.1007/s00595-006-3287-5
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00595-006-3287-5