Predictors of objectively identified recurrent reflux after primary Nissen fundoplication
Background: Laparoscopic Nissen fundoplication is the most frequently performed operation for gastro‐oesophageal reflux disease (GORD). Studies on predictors of subjective outcome of fundoplication have yielded inconsistent results. This study identified predictors of objective reflux control after...
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| Veröffentlicht in: | British journal of surgery 2011-05, Vol.98 (5), p.673-679 |
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| creator | Broeders, J. A. J. L. Roks, D. J. G. H. Draaisma, W. A. Vlek, A. L. M. Hazebroek, E. J. Broeders, I. A. M. J. Smout, A. J. P. M. |
| description | Background:
Laparoscopic Nissen fundoplication is the most frequently performed operation for gastro‐oesophageal reflux disease (GORD). Studies on predictors of subjective outcome of fundoplication have yielded inconsistent results. This study identified predictors of objective reflux control after Nissen fundoplication.
Methods:
This was a retrospective analysis of prospectively collected data from patients who underwent Nissen fundoplication for proton pump inhibitor‐refractory GORD with pathological acid exposure in a single centre between 1997 and 2005. The predictive value of demographics, endoscopic hiatal hernia size, oesophagitis, lower oesophageal sphincter pressure, distal oesophageal contraction amplitude, percentage of peristaltic contractions and acid exposure was determined. Endpoints were recurrent pathological acid exposure on 24‐h pH monitoring at 6 months and surgical reintervention for recurrent GORD up to 6 years.
Results:
Of 177 patients, 22 had recurrent pathological acid exposure at 6 months for which 11 had surgery within 6 years. Only low percentage of peristaltic contractions (odds ratio (OR) 0·97, 95 per cent confidence interval 0·95 to 0·99; P = 0·004) and high supine acid exposure (OR 1·03, 1·00 to 1·07; P = 0·025) were independent predictors of recurrent pathological acid exposure. The absolute risk of recurrent exposure was 45·5 per cent in patients with both predictors. High supine acid exposure was also an independent predictor of surgical reintervention (OR 1·05, 1·01 to 1·08; P = 0·006).
Conclusion:
Nissen fundoplication should not necessarily be withheld from patients with poor oesophageal peristalsis or excessive supine acid exposure. As about half of patients with both variables experience recurrent pathological acid exposure after primary Nissen fundoplication, surgery should be restricted in this group. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Worth the effort |
| doi_str_mv | 10.1002/bjs.7411 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_860178965</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>860178965</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3891-314b6676efc53f2ff0668d14a43440430edba041a6b0ca2918a5e470c95ffbda3</originalsourceid><addsrcrecordid>eNpF0ctO4zAUBmALMYLSQeIJUDaIVZjja5IlIC4zU3W4CrGyHOdYckmTYidA355UdMrq2PIn69f5CTmgcEIB2K9yFk8yQekWGVGuZMqoyrfJCACylHLGd8lejDMAykGyHbLLKJMCBBuR55uAlbddG2LSuqQtZ2g7_4b1MvEVNp13HqskoO1DGK7DydX9R2JchyFZBD83YZlMfYzYJK5vqnZRe2s63zY_yQ9n6oj76zkmj5cXD-fX6eTf1e_z00lqeV7QlFNRKpUpdFZyx5wDpfKKCiO4GCJywKo0IKhRJVjDCpobiSIDW0jnysrwMTn--ncR2tceY6fnPlqsa9Ng20edK6BZXig5yMO17Ms5VnodX__fxgCO1sBEa2oXTGN9_HYClCyGTGOSfrl3X-Ny805Br9rQQxt61YY--3O_mt_exw4_Nt6EF60ynkn9NL3Sk9unO_737Ebf80_-S4v6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>860178965</pqid></control><display><type>article</type><title>Predictors of objectively identified recurrent reflux after primary Nissen fundoplication</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Broeders, J. A. J. L. ; Roks, D. J. G. H. ; Draaisma, W. A. ; Vlek, A. L. M. ; Hazebroek, E. J. ; Broeders, I. A. M. J. ; Smout, A. J. P. M.</creator><creatorcontrib>Broeders, J. A. J. L. ; Roks, D. J. G. H. ; Draaisma, W. A. ; Vlek, A. L. M. ; Hazebroek, E. J. ; Broeders, I. A. M. J. ; Smout, A. J. P. M.</creatorcontrib><description>Background:
Laparoscopic Nissen fundoplication is the most frequently performed operation for gastro‐oesophageal reflux disease (GORD). Studies on predictors of subjective outcome of fundoplication have yielded inconsistent results. This study identified predictors of objective reflux control after Nissen fundoplication.
Methods:
This was a retrospective analysis of prospectively collected data from patients who underwent Nissen fundoplication for proton pump inhibitor‐refractory GORD with pathological acid exposure in a single centre between 1997 and 2005. The predictive value of demographics, endoscopic hiatal hernia size, oesophagitis, lower oesophageal sphincter pressure, distal oesophageal contraction amplitude, percentage of peristaltic contractions and acid exposure was determined. Endpoints were recurrent pathological acid exposure on 24‐h pH monitoring at 6 months and surgical reintervention for recurrent GORD up to 6 years.
Results:
Of 177 patients, 22 had recurrent pathological acid exposure at 6 months for which 11 had surgery within 6 years. Only low percentage of peristaltic contractions (odds ratio (OR) 0·97, 95 per cent confidence interval 0·95 to 0·99; P = 0·004) and high supine acid exposure (OR 1·03, 1·00 to 1·07; P = 0·025) were independent predictors of recurrent pathological acid exposure. The absolute risk of recurrent exposure was 45·5 per cent in patients with both predictors. High supine acid exposure was also an independent predictor of surgical reintervention (OR 1·05, 1·01 to 1·08; P = 0·006).
Conclusion:
Nissen fundoplication should not necessarily be withheld from patients with poor oesophageal peristalsis or excessive supine acid exposure. As about half of patients with both variables experience recurrent pathological acid exposure after primary Nissen fundoplication, surgery should be restricted in this group. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Worth the effort</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.7411</identifier><identifier>PMID: 21254042</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Biological and medical sciences ; Esophageal pH Monitoring ; Esophagoscopy - methods ; Female ; Fundoplication - methods ; Gastric Acidity Determination ; Gastroesophageal Reflux - surgery ; General aspects ; Humans ; Long-Term Care ; Male ; Manometry - methods ; Medical sciences ; Middle Aged ; Prospective Studies ; Recurrence ; Reoperation - statistics & numerical data ; Retrospective Studies</subject><ispartof>British journal of surgery, 2011-05, Vol.98 (5), p.673-679</ispartof><rights>Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3891-314b6676efc53f2ff0668d14a43440430edba041a6b0ca2918a5e470c95ffbda3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.7411$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.7411$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,45583,45584</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24065904$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21254042$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Broeders, J. A. J. L.</creatorcontrib><creatorcontrib>Roks, D. J. G. H.</creatorcontrib><creatorcontrib>Draaisma, W. A.</creatorcontrib><creatorcontrib>Vlek, A. L. M.</creatorcontrib><creatorcontrib>Hazebroek, E. J.</creatorcontrib><creatorcontrib>Broeders, I. A. M. J.</creatorcontrib><creatorcontrib>Smout, A. J. P. M.</creatorcontrib><title>Predictors of objectively identified recurrent reflux after primary Nissen fundoplication</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background:
Laparoscopic Nissen fundoplication is the most frequently performed operation for gastro‐oesophageal reflux disease (GORD). Studies on predictors of subjective outcome of fundoplication have yielded inconsistent results. This study identified predictors of objective reflux control after Nissen fundoplication.
Methods:
This was a retrospective analysis of prospectively collected data from patients who underwent Nissen fundoplication for proton pump inhibitor‐refractory GORD with pathological acid exposure in a single centre between 1997 and 2005. The predictive value of demographics, endoscopic hiatal hernia size, oesophagitis, lower oesophageal sphincter pressure, distal oesophageal contraction amplitude, percentage of peristaltic contractions and acid exposure was determined. Endpoints were recurrent pathological acid exposure on 24‐h pH monitoring at 6 months and surgical reintervention for recurrent GORD up to 6 years.
Results:
Of 177 patients, 22 had recurrent pathological acid exposure at 6 months for which 11 had surgery within 6 years. Only low percentage of peristaltic contractions (odds ratio (OR) 0·97, 95 per cent confidence interval 0·95 to 0·99; P = 0·004) and high supine acid exposure (OR 1·03, 1·00 to 1·07; P = 0·025) were independent predictors of recurrent pathological acid exposure. The absolute risk of recurrent exposure was 45·5 per cent in patients with both predictors. High supine acid exposure was also an independent predictor of surgical reintervention (OR 1·05, 1·01 to 1·08; P = 0·006).
Conclusion:
Nissen fundoplication should not necessarily be withheld from patients with poor oesophageal peristalsis or excessive supine acid exposure. As about half of patients with both variables experience recurrent pathological acid exposure after primary Nissen fundoplication, surgery should be restricted in this group. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Worth the effort</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Esophageal pH Monitoring</subject><subject>Esophagoscopy - methods</subject><subject>Female</subject><subject>Fundoplication - methods</subject><subject>Gastric Acidity Determination</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>General aspects</subject><subject>Humans</subject><subject>Long-Term Care</subject><subject>Male</subject><subject>Manometry - methods</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Recurrence</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpF0ctO4zAUBmALMYLSQeIJUDaIVZjja5IlIC4zU3W4CrGyHOdYckmTYidA355UdMrq2PIn69f5CTmgcEIB2K9yFk8yQekWGVGuZMqoyrfJCACylHLGd8lejDMAykGyHbLLKJMCBBuR55uAlbddG2LSuqQtZ2g7_4b1MvEVNp13HqskoO1DGK7DydX9R2JchyFZBD83YZlMfYzYJK5vqnZRe2s63zY_yQ9n6oj76zkmj5cXD-fX6eTf1e_z00lqeV7QlFNRKpUpdFZyx5wDpfKKCiO4GCJywKo0IKhRJVjDCpobiSIDW0jnysrwMTn--ncR2tceY6fnPlqsa9Ng20edK6BZXig5yMO17Ms5VnodX__fxgCO1sBEa2oXTGN9_HYClCyGTGOSfrl3X-Ny805Br9rQQxt61YY--3O_mt_exw4_Nt6EF60ynkn9NL3Sk9unO_737Ebf80_-S4v6</recordid><startdate>201105</startdate><enddate>201105</enddate><creator>Broeders, J. A. J. L.</creator><creator>Roks, D. J. G. H.</creator><creator>Draaisma, W. A.</creator><creator>Vlek, A. L. M.</creator><creator>Hazebroek, E. J.</creator><creator>Broeders, I. A. M. J.</creator><creator>Smout, A. J. P. M.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201105</creationdate><title>Predictors of objectively identified recurrent reflux after primary Nissen fundoplication</title><author>Broeders, J. A. J. L. ; Roks, D. J. G. H. ; Draaisma, W. A. ; Vlek, A. L. M. ; Hazebroek, E. J. ; Broeders, I. A. M. J. ; Smout, A. J. P. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3891-314b6676efc53f2ff0668d14a43440430edba041a6b0ca2918a5e470c95ffbda3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Esophageal pH Monitoring</topic><topic>Esophagoscopy - methods</topic><topic>Female</topic><topic>Fundoplication - methods</topic><topic>Gastric Acidity Determination</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>General aspects</topic><topic>Humans</topic><topic>Long-Term Care</topic><topic>Male</topic><topic>Manometry - methods</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Recurrence</topic><topic>Reoperation - statistics & numerical data</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Broeders, J. A. J. L.</creatorcontrib><creatorcontrib>Roks, D. J. G. H.</creatorcontrib><creatorcontrib>Draaisma, W. A.</creatorcontrib><creatorcontrib>Vlek, A. L. M.</creatorcontrib><creatorcontrib>Hazebroek, E. J.</creatorcontrib><creatorcontrib>Broeders, I. A. M. J.</creatorcontrib><creatorcontrib>Smout, A. J. P. M.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Broeders, J. A. J. L.</au><au>Roks, D. J. G. H.</au><au>Draaisma, W. A.</au><au>Vlek, A. L. M.</au><au>Hazebroek, E. J.</au><au>Broeders, I. A. M. J.</au><au>Smout, A. J. P. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of objectively identified recurrent reflux after primary Nissen fundoplication</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2011-05</date><risdate>2011</risdate><volume>98</volume><issue>5</issue><spage>673</spage><epage>679</epage><pages>673-679</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background:
Laparoscopic Nissen fundoplication is the most frequently performed operation for gastro‐oesophageal reflux disease (GORD). Studies on predictors of subjective outcome of fundoplication have yielded inconsistent results. This study identified predictors of objective reflux control after Nissen fundoplication.
Methods:
This was a retrospective analysis of prospectively collected data from patients who underwent Nissen fundoplication for proton pump inhibitor‐refractory GORD with pathological acid exposure in a single centre between 1997 and 2005. The predictive value of demographics, endoscopic hiatal hernia size, oesophagitis, lower oesophageal sphincter pressure, distal oesophageal contraction amplitude, percentage of peristaltic contractions and acid exposure was determined. Endpoints were recurrent pathological acid exposure on 24‐h pH monitoring at 6 months and surgical reintervention for recurrent GORD up to 6 years.
Results:
Of 177 patients, 22 had recurrent pathological acid exposure at 6 months for which 11 had surgery within 6 years. Only low percentage of peristaltic contractions (odds ratio (OR) 0·97, 95 per cent confidence interval 0·95 to 0·99; P = 0·004) and high supine acid exposure (OR 1·03, 1·00 to 1·07; P = 0·025) were independent predictors of recurrent pathological acid exposure. The absolute risk of recurrent exposure was 45·5 per cent in patients with both predictors. High supine acid exposure was also an independent predictor of surgical reintervention (OR 1·05, 1·01 to 1·08; P = 0·006).
Conclusion:
Nissen fundoplication should not necessarily be withheld from patients with poor oesophageal peristalsis or excessive supine acid exposure. As about half of patients with both variables experience recurrent pathological acid exposure after primary Nissen fundoplication, surgery should be restricted in this group. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Worth the effort</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>21254042</pmid><doi>10.1002/bjs.7411</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 2011-05, Vol.98 (5), p.673-679 |
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| source | MEDLINE; Access via Wiley Online Library; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Aged Biological and medical sciences Esophageal pH Monitoring Esophagoscopy - methods Female Fundoplication - methods Gastric Acidity Determination Gastroesophageal Reflux - surgery General aspects Humans Long-Term Care Male Manometry - methods Medical sciences Middle Aged Prospective Studies Recurrence Reoperation - statistics & numerical data Retrospective Studies |
| title | Predictors of objectively identified recurrent reflux after primary Nissen fundoplication |
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