| Upright, supine, or bipositional reflux: patterns of reflux do not affect outcome after laparoscopic Nissen fundoplication. | |
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MedLine Citation:
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PMID: 17522933 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: This study was undertaken to determine if the body position in which gastroesophageal reflux occurs before fundoplication--i.e., pattern of reflux--affects symptoms before or after laparoscopic Nissen fundoplication. METHODS: A total of 417 patients with gastroesophageal reflux disease (GERD) underwent pH studies, and the severity of reflux in the upright and supine positions was determined. The percent time with pH less than 4 was used to assign patients to one of four groups: upright reflux (pH < 4 more than 8.3% of time in upright position, n = 80), supine reflux (pH < 4 more than 3.5% of time in supine position, n = 73), bipositional reflux (both supine and upright reflux, n = 163), or neither (n = 101). Before and after laparoscopic Nissen fundoplication, the frequency and severity of symptoms of reflux (e.g., dysphagia, regurgitation, choking, heartburn, chest pain) were scored on a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). For each patient, symptom scores before versus after fundoplication were compared using the Wilcoxon matched pairs test; comparisons of symptom scores among patients grouped by reflux patterns were made using Kruskal-Wallis test. RESULTS: Before fundoplication, the patterns of reflux did not affect the frequency or severity of reflux symptoms. After laparoscopic fundoplication, all symptoms of bipositional reflux improved, and essentially all symptoms of isolated supine or upright reflux or neither improved. CONCLUSIONS: Preoperatively, regardless of the patterns of reflux, symptoms among patients were similar. After fundoplication, symptoms of GERD improved for all patterns of reflux. Laparoscopic fundoplication imparts dramatic and broad relief of symptoms of GERD, regardless of the patterns of reflux. Application of laparoscopic Nissen fundoplication is encouraged. |
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Authors:
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S M Cowgill; S Al-Saadi; D Villadolid; D Arnaoutakis; D Molloy; A S Rosemurgy |
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Publication Detail:
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Type: Journal Article Date: 2007-05-24 |
Journal Detail:
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Title: Surgical endoscopy Volume: 21 ISSN: 1432-2218 ISO Abbreviation: Surg Endosc Publication Date: 2007 Dec |
Date Detail:
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Created Date: 2007-11-16 Completed Date: 2007-12-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8806653 Medline TA: Surg Endosc Country: Germany |
Other Details:
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Languages: eng Pagination: 2193-8 Citation Subset: IM |
Affiliation:
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Department of Surgery, Digestive Disorders Center, Tampa General Hospital arosemur@health.usf.edu. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Female Fundoplication* Gastroesophageal Reflux / physiopathology*, surgery* Humans Laparoscopy* Male Middle Aged Patient Satisfaction Posture* Severity of Illness Index Supine Position Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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