Secrets for successful laparoscopic antireflux surgery
Editorial

Secrets for successful laparoscopic antireflux surgery

Fernando Augusto Mardiros Herbella

Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil

Correspondence to: Dr. Fernando Augusto Mardiros Herbella, MD. Department of Surgery, Escola Paulista de Medicina, Rua Diogo de Faria 1087 cj 301 Sao Paulo, SP 04037-003, Brazil. Email: herbella.dcir@epm.br.

Received: 31 December 2016; Accepted: 01 January 2017; Published: 30 March 2017.

doi: 10.21037/ales.2017.02.02


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

Acknowledgements

None.


Footnote

Conflicts of Interest: The author has no conflicts of interest to declare.


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]
doi: 10.21037/ales.2017.02.02
Cite this article as: Herbella FA. Secrets for successful laparoscopic antireflux surgery. Ann Laparosc Endosc Surg 2017;2:46.