J Korean Surg Soc.  2013 Jun;84(6):330-337. 10.4174/jkss.2013.84.6.330.

Early experiences of minimally invasive surgery to treat gastroesophageal reflux disease

• Lee SB
• Jeon KM
• Kim BS
• Kim KC
• Jung HY
• Choi YB

• KMID: 1505182
• DOI: http://doi.org/10.4174/jkss.2013.84.6.330

Abstract

PURPOSE
There are fewer patients with gastroesophageal reflux disease (GERD) in Korea compared with Western countries. The incidence of GERD has increased in recent years however, concerning many physicians. Here, we report our early experiences of using a recently introduced method of laparoscopic antireflux surgery for the treatment of GERD in Korean patients.
METHODS
Fifteen patients with GERD were treated using antireflux surgery between May 2009 and February 2012 at the University of Ulsan College of Medicine and Asan Medical Center. Laparoscopic Nissen fundoplication with 360degrees wrapping was performed on all patients.
RESULTS
Eleven male and four female patients were evaluated and treated with an average age of 58.1 +/- 14.1 years. The average surgical time was 118.9 +/- 45.1 minutes, and no complications presented during surgery. After surgery, the reflux symptoms of each patient were resolved; only two patients developed transient dysphagia, which resolved within one month. One patient developed a 6-cm hiatal hernia that had to be repaired and reinforced using mesh.
CONCLUSION
The use of laparoscopic surgery for the treatment of GERD is safe and feasible. It is also an efficacious method for controlling the symptoms of GERD in Korean patients. However, the use of this surgery still needs to be standardized (e.g., type of surgery, bougienage size, wrap length) and the long-term outcomes need to be evaluated.

Keyword

Gastroesophageal reflux; Antireflux surgery; Nissen fundoplication; Laparoscopy

MeSH Terms

Deglutition Disorders
Female
Fundoplication
Gastroesophageal Reflux
Hernia, Hiatal
Humans
Incidence
Korea
Laparoscopy
Male
Operative Time

Figure

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  Fig. 1 Trocar placement for laparoscopic fundoplication. Two 12 mm trocars and three 5 mm trocars are shown.

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  Fig. 2 (A-C) A 42-year-old female patient was administered 30 mg lansoprazole QD for 17 months, but was hospitalized due to the lack of improvement in dysphagia. (A) Preoperative upper gatrointestinal (GI) endoscopy. Semicircular erosions (occupying about 75% of the lumen) are noted on the lower esophagus, including multiple linear mucosal breaks. Focal upward projection of the Z-line with salmon-colored mucosal changes is also noted. (B) Fourteen months later, postoperative upper GI endoscopy was performed, demonstrating that the erosion of the Z-line was alleviated and reflux esophagitis was resolved. (C) Seven months later, postoperative barium esophagography was performed, demonstrating no evidence of extraluminal contrast leakage or significant contrast passage disturbances at the gastroesophageal junction. Proximal esophageal dilatation improved but still remained. Symptoms were alleviated after surgery, so the patient stopped taking lansoprazole. (D-F) A 67-year-old female patient was administered 40 mg esomeprazole QD for 8 months, but was hospitalized due to the lack of improvement in regurgitation. (D) Preoperative upper GI endoscopy. Reflux esophagitis is noted on the lower esophagus, including two 6 mm mucosal breaks. (E) After 28 months, postoperative upper GI endoscopy was performed, demonstrating reflux esophagitis with recurrent mucosal breaks and ulcerations. (F) After three months, a postoperative barium esophagography was performed, demonstrating mild luminal narrowing at the anastomotic site and no significant passage disturbances. Eight months after surgery, the patient is still being administered the same dose of esomeprazole for five months due to the lack of symptom improvement.

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