Top

Published in:

01-03-2017 | Original Article

Post-Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication

Authors: Katrin Schwameis, Jörg Zehetner, Kais Rona, Peter Crookes, Nikolai Bildzukewicz, Daniel S. Oh, Geoffrey Ro, Katherine Ross, Kulmeet Sandhu, Namir Katkhouda, Jeffrey A. Hagen, John C. Lipham

Published in: Journal of Gastrointestinal Surgery | Issue 3/2017

Abstract

Introduction

Protracted dysphagia and bloating are potential troublesome side effects following Nissen fundoplication. The aim of this study was to evaluate the effects of conversion from Nissen to Toupet on dysphagia and bloating.

Methods

The study used a retrospective chart review of all patients who had undergone conversion from Nissen to Toupet between 2001 and 2014. Endpoints were to determine the effect of conversion on dysphagia, bloating, and reflux control.

Results

Twenty-five patients underwent conversion at a median of 3.7 years (1.4–10.5) after initial fundoplication. Indications were dysphagia in 19 (76%) and bloating syndrome in 6 (24%) patients. The median operative time was 104 min (86–146). There were no serious complications or mortality. Median follow-up was 27 months (0.8–130). Dysphagia was relieved in 16 (84%) and bloating in all 6 patients. Two patients developed reflux requiring a redo-Nissen. Two patients had persistent dysphagia and required endoscopic dilation. The GERD-HRQL post-conversion showed a median score of 5 (3–13).

Conclusions

Conversion relieved dysphagia in 84% and bloating in 100%. Significant recurrence of GERD was rare. Given the absence of serious complications, conversion should be considered in patients with severe bloating or dysphagia.

El-Serag HB, Sweet S, Winchester CC, Dent J: Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014, 63:871–880.CrossRefPubMed

Kelly JJ, Watson DI, Chin KF, Devitt PG, Game PA, Jamieson GG: Laparoscopic Nissen fundoplication: clinical outcomes at 10 years. J Am Coll Surg 2007, 205:570–575.CrossRefPubMed

Gee DW, Andreoli MT, Rattner DW: Measuring the effectiveness of laparoscopic antireflux surgery: long-term results. Arch Surg 2008, 143:482–487.CrossRefPubMed

Anvari M, Allen C: Five-year comprehensive outcomes evaluation in 181 patients after laparoscopic Nissen fundoplication. J Am Coll Surg 2003, 196:51–57; discussion 57–58; author reply 58–59.CrossRefPubMed

Mickevicius A, Endzinas Z, Kiudelis M, Jonaitis L, Kupcinskas L, Pundzius J, Maleckas A: Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study. Surg Endosc 2013, 27:986–991.CrossRefPubMed

Velanovich V: The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 2007, 20:130–134.CrossRefPubMed

Velanovich V: Comparison of generic (SF-36) vs. disease-specific (GERD-HRQL) quality-of-life scales for gastroesophageal reflux disease. J Gastrointest Surg 1998, 2:141–145.CrossRefPubMed

Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA: Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg 1996, 183:217–224.PubMed

Wills VL, Hunt DR: Dysphagia after antireflux surgery. Br J Surg 2001, 88:486–499.CrossRefPubMed

10.

Hunter JG, Swanstrom L, Waring JP: Dysphagia after laparoscopic antireflux surgery. The impact of operative technique. Ann Surg 1996, 224:51–57.

11.

Stein HJ, Balint A: Surgery for gastro-oesophageal reflux disease: laparoscopic versus traditional approach. Ital J Gastroenterol Hepatol 1997, 29:391–394.PubMed

12.

Pitcher DE, Curet MJ, Martin DT, Castillo RR, Gerstenberger PD, Vogt D, Zucker KA: Successful management of severe gastroesophageal reflux disease with laparoscopic Nissen fundoplication. Am J Surg 1994, 168:547–553; discussion 553–544.CrossRefPubMed

13.

Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR, Perdikis G: Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 1994, 220:472–481; discussion 481–473.CrossRefPubMedPubMedCentral

14.

Galmiche JP, Hatlebakk J, Attwood S, Ell C, Fiocca R, Eklund S, Langstrom G, Lind T, Lundell L, Collaborators LT: Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 2011, 305:1969–1977.CrossRefPubMed

15.

Dallemagne B, Weerts J, Markiewicz S, Dewandre JM, Wahlen C, Monami B, Jehaes C: Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2006, 20:159–165.CrossRefPubMed

16.

Guerin E, Betroune K, Closset J, Mehdi A, Lefebvre JC, Houben JJ, Gelin M, Vaneukem P, El Nakadi I: Nissen versus Toupet fundoplication: results of a randomized and multicenter trial. Surg Endosc 2007, 21:1985–1990.CrossRefPubMed

17.

Strate U, Emmermann A, Fibbe C, Layer P, Zornig C: Laparoscopic fundoplication: Nissen versus Toupet two-year outcome of a prospective randomized study of 200 patients regarding preoperative esophageal motility. Surg Endosc 2008, 22:21–30.CrossRefPubMed

18.

Gad El-Hak N, Mostafa M, Hamdy E, Haleem M: Short and long-term results of laparoscopic total fundic wrap (Nissen) or semifundoplication (Toupet) for gastroesophageal reflux disease. Hepatogastroenterology 2014, 61:1961–1970.PubMed

19.

Wo JM, Trus TL, Richardson WS, Hunter JG, Branum GD, Mauren SJ, Waring JP: Evaluation and management of postfundoplication dysphagia. Am J Gastroenterol 1996, 91:2318–2322.PubMed

20.

Malhi-Chowla N, Gorecki P, Bammer T, Achem SR, Hinder RA, Devault KR: Dilation after fundoplication: timing, frequency, indications, and outcome. Gastrointest Endosc 2002, 55:219–223.CrossRefPubMed

21.

Hui JM, Hunt DR, de Carle DJ, Williams R, Cook IJ: Esophageal pneumatic dilation for postfundoplication dysphagia: safety, efficacy, and predictors of outcome. Am J Gastroenterol 2002, 97:2986–2991.CrossRefPubMed

22.

Skinner DB: Surgical management after failed antireflux operations. World J Surg 1992, 16:359–363.CrossRefPubMed

23.

Hashimi S, Bremner RM: Complications Following Surgery for Gastroesophageal Reflux Disease and Achalasia. Thorac Surg Clin 2015, 25:485–498.CrossRefPubMed

24.

Draaisma WA, Rijnhart-de Jong HG, Broeders IA, Smout AJ, Furnee EJ, Gooszen HG: Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication: a randomized trial. Ann Surg 2006, 244:34–41.CrossRefPubMedPubMedCentral

25.

Khaitan L, Bhatt P, Richards W, Houston H, Sharp K, Holzman M: Comparison of patient satisfaction after redo and primary fundoplications. Surg Endosc 2003, 17:1042–1045.CrossRefPubMed

26.

Richter JE: Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastroenterol Hepatol 2013, 11:465–471; quiz e439.

27.

Bais JE, Wijnhoven BP, Masclee AA, Smout AJ, Gooszen HG: Analysis and surgical treatment of persistent dysphagia after Nissen fundoplication. Br J Surg 2001, 88:569–576.CrossRefPubMed

28.

McKellar SH, Allen MS, Cassivi SD, Nichols FC, 3rd, Shen KR, Wigle DA, Deschamps C: Laparoscopic conversion from Nissen to partial fundoplication for refractory dysphagia. Ann Thorac Surg 2011, 91:932–934.CrossRefPubMed

Title: Post-Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication
Authors: Katrin Schwameis
Jörg Zehetner
Kais Rona
Peter Crookes
Nikolai Bildzukewicz
Daniel S. Oh
Geoffrey Ro
Katherine Ross
Kulmeet Sandhu
Namir Katkhouda
Jeffrey A. Hagen
John C. Lipham
Publication date: 01-03-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 3/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3320-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Post-Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2017

Quantitative Assessment of Visceral Obesity and Postoperative Colon Cancer Outcomes

Gastric Outlet Obstruction due to Gastrointestinal Amyloidosis

Emergent Colectomy Is Independently Associated with Decreased Long-Term Overall Survival in Colon Cancer Patients

Performing the Difficult Cholecystectomy Using Combined Endoscopic and Robotic Techniques: How I Do It

Robotic Total Mesorectal Excision for Rectal Cancer: A Series of 392 Cases and Mid-Term Outcomes from A Single Center in China

Effect of Oral ω3-Polyunsaturated Fatty Acids as a Complement Management to Control Fistula Output and Inflammation in Patients With Digestive Fistula