Año 2025 / Volumen 117 / Número 6
Original
Clinical and functional factors influencing the outcome of laparoscopic Nissen fundoplication

319-326

DOI: 10.17235/reed.2025.10615/2024

Constanza Ciriza de los Ríos, Laura Gil Remezal, Francisco Javier Molano Nogueira, Laura García Pravia, Andrés Sánchez Pernaute, Enrique Rey,

Resumen
Background and aim: laparoscopic Nissen fundoplication (LNF) is the gold standard of antireflux surgery. Up to 30 % of patients experience symptoms after surgery, with insufficient information available. The main objective was to evaluate epidemiological, clinical, and functional factors associated with symptoms after LNF. Methods: a retrospective case-control study was performed of 79 operated patients (2015-2024). The relationship between epidemiological data, functional tests, and imaging study results with the occurrence of symptoms after LNF was assessed. Results: twenty-four asymptomatic and 55 symptomatic patients were included. Functional and imaging tests were normal in the majority of asymptomatic patients. integrated relaxation pressure over 4 seconds (IRP-4s) (95th percentile) in asymptomatic patients was 20.4 mmHg. Female gender (OR 4, 95 % CI: 1.1-14), preoperative dysphagia (OR 8.2, 95 % CI: 1.4-47.6), and IRP-4s (OR 1.2, 95 % CI: 1-1.3) were independent factors for postoperative dysphagia. Type III esophagogastric junction morphology on high-resolution manometry (OR 6.1, 95 % CI: 2.1-18.1) was independently associated with gastroesophageal reflux disease (GERD) symptoms. Acid exposure time (AET) showed a trend toward being an independent factor but did not reach statistical significance (OR 1.1, 95 % CI: 1-1.3). Hiatal hernia in the esophagogram was associated with reintervention (OR 5.5, 95 % CI: 1.6-19.1). Conclusions: asymptomatic patients mostly have normal functional tests after LNF, although IRP-4s normal value (95th percentile) is higher than proposed in the Chicago classification. Preoperative dysphagia and female gender are independent factors for postoperative dysphagia, which should be considered in the preoperative assessment. Functional and imaging tests are essential in evaluating patients with postoperative symptoms. Dysphagia is associated with higher IRP while GERD symptoms are related to type III esophagogastric junction (EGJ) on high resolution manometry (HRM). Similarly, a hiatal hernia on the esophagogram is associated with reintervention.
Resumen coloquial
Gastroesophageal reflux disease (GERD) results from gastric content reflux, causing symptoms or complications. Its global prevalence is 13%. Treatment typically involves acid suppression, with proton pump inhibitors (PPIs) as the first choice. For poor responders, laparoscopic Nissen fundoplication (LNF) is the preferred surgical option, showing over 90% long-term efficacy. However, up to 30% of cases may experience persistent or recurrent symptoms post-surgery. In a study of 79 LNF patients, 24 were asymptomatic and 55 symptomatic. Functional tests (esophageal manometry and pH studies) were conducted on all, with imaging studies for most. Asymptomatic patients generally showed normal functional tests, though IRP-4s (95th-percentile) is 20.4 mmHg, higher than proposed in the Chicago Classification. Preoperative dysphagia and female gender independently increase the risk of postoperative dysphagia and should be assessed pre-surgery. Functional and imaging tests are key in diagnosing postoperative issues, identifying causes, and determining the need for reoperation. Dysphagia correlates with higher IRP, GERD symptoms with type-III EGJ and elevated AET, and hiatal hernia on esophagogram with the need for REDO surgery.
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Bibliografía
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Ciriza de los Ríos C, Gil Remezal L, Molano Nogueira F, García Pravia L, Sánchez Pernaute A, Rey E, et all. Clinical and functional factors influencing the outcome of laparoscopic Nissen fundoplication. 10615/2024


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Ficha Técnica

Recibido: 25/06/2024

Aceptado: 08/01/2025

Prepublicado: 20/01/2025

Publicado: 10/06/2025

Tiempo de revisión del artículo: 191 días

Tiempo de prepublicación: 209 días

Tiempo de edición del artículo: 350 días


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