Secrets for successful laparoscopic antireflux surgery

Gastroesophageal reflux disease (GERD) is high prevalent in the modern World with over 240,000,000 individuals suffering from the disease (1). This leads to an estimated 7 million diagnoses of GERD per year in the US only (2), with over 6.2 million ambulatory visits (2) and direct cost exceeding 9 billion dollars (3). Despite this high prevalence with associated impressive cost and decreased quality of life (4) the discrepancy between the number of patients who experience suboptimal medical treatment and the number considered for antireflux surgery indicates a large therapeutic gap in the management of GERD (4). Antireflux surgery has been shown to provide cost-effective long-term good outcomes (5,6); however, the number of operations is decreasing yearly (7). This may be linked to unfounded concepts that misguide indication for surgery (1) but also to suboptimal results.

Experienced groups achieve good and excellent results in more than 90% of patients submitted to laparoscopic Nissen fundoplication (8-11). These figures are obtained due to a critical selection of patients—encompassing the certainty of the diagnoses of GERD, evaluation of esophageal status and exclusion of other diseases—and a proper surgical technique. This Annals of Laparoscopic and Endoscopic Surgery (ALES)-special issue on “Secrets for Successful Laparoscopic Antireflux Surgery” shows the tips and tricks of high experienced esophageal surgeons to achieve good and excellent results in patients with GERD, from the initial workup to the operation, including the demands of special groups of patients such as those with extra-esophageal symptoms, connective tissue diseases or GERD-related lung diseases; from the highest technology available with a robotic platform to a community hospital reality.

Dr. Fernando Augusto Mardiros Herbella

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Laparoscopic and Endoscopic Surgery for the series “Secrets for Successful Laparoscopic Antireflux Surgery”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/ales.2017.02.02). The series “Secrets for Successful Laparoscopic Antireflux Surgery” was commissioned by the editorial office without any funding or sponsorship. Herbella FA served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Armijo PR, Herbella FA, Patti MG. Surgical treatment of gastroesophageal reflux disease. A review of concepts that misguide indication for surgery. J Minim Invasive Surg Sci 2106;5:e33995.
2. Peery AF, Crockett SD, Barritt AS, et al. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology 2015;149:1731-41.e3. [Crossref] [PubMed]
3. Shaheen NJ, Hansen RA, Morgan DR, et al. The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 2006;101:2128-38. [Crossref] [PubMed]
4. Perry KA, Pham TH, Spechler SJ, et al. 2014 SSAT State-of-the-Art Conference: advances in diagnosis and management of gastroesophageal reflux disease. J Gastrointest Surg 2015;19:458-66. [Crossref] [PubMed]
5. Sadowitz BD, Luberice K, Bowman TA, et al. A Single Institution's First 100 Patients Undergoing Laparoscopic Anti-Reflux Fundoplications: Where Are They 20 Years Later? Am Surg 2015;81:791-7. [PubMed]
6. Gawron AJ, French DD, Pandolfino JE, et al. Economic evaluations of gastroesophageal reflux disease medical management. Pharmacoeconomics 2014;32:745-58. [Crossref] [PubMed]
7. Wang YR, Dempsey DT, Richter JE. Trends and perioperative outcomes of inpatient antireflux surgery in the United States, 1993-2006. Dis Esophagus 2011;24:215-23. [Crossref] [PubMed]
8. Morgenthal CB, Shane MD, Stival A, et al. The durability of laparoscopic Nissen fundoplication: 11-year outcomes. J Gastrointest Surg 2007;11:693-700. [Crossref] [PubMed]
9. Eubanks TR, Omelanczuk P, Richards C, et al. Outcomes of laparoscopic antireflux procedures. Am J Surg 2000;179:391-5. [Crossref] [PubMed]
10. Peters JH, DeMeester TR, Crookes P, et al. The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with "typical" symptoms. Ann Surg 1998;228:40-50. [Crossref] [PubMed]
11. Dallemagne B, Weerts J, Markiewicz S, et al. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2006;20:159-65. [Crossref] [PubMed]