Indications, Principles of Procedure Selection, and Technique of Laparoscopic Nissen Fundoplication: Influence Statistics

Expert Impact

Concepts for which they have has direct influence: Antireflux surgery , Gastroesophageal reflux , Laparoscopic fundoplication , Chest pain , Nissen fundoplication , Surgical therapy , Gastroesophageal reflux disease .

Key People For Antireflux Surgery

Top KOLs in the world
#1
Tom R DeMeester
gastroesophageal reflux intestinal metaplasia esophageal adenocarcinoma
#2
Jeffrey H Peters
gastroesophageal reflux disease esophageal adenocarcinoma antireflux surgery
#3
Ronald A Hinder
antireflux surgery gastroesophageal reflux disease medical therapy
#4
Stuart Jon Spechler
barrett esophagus eosinophilic esophagitis intestinal metaplasia
#5
John G Hunter
esophageal cancer laparoscopic cholecystectomy nissen fundoplication
#6
Cedric G Bremner
gastroesophageal reflux disease nissen fundoplication antireflux surgery

Indications, Principles of Procedure Selection, and Technique of Laparoscopic Nissen Fundoplication

Abstract

. The successful performance of antireflux surgery is a significant therapeutic challenge. Simple reliance on patient symptomatology is inadequate to establish a diagnosis of gastroesophageal reflux and select patients for surgical therapy. Foregut symptoms are common and nonspecific. Not infrequently, gastroesophageal reflux disease can give rise to atypical symptoms, including asthma, chest pain, chronic cough, wheezing, and hoarseness. Objective documentation of gastroesophageal reflux via 24-hour pH monitoring is required. Additionally, the performance of antireflux surgery that successfully relieves symptoms in over 90% of patients without undue morbidity or the creation of new symptoms is more difficult than readily apparent. This is particularly true for the surgeon undertaking occasional antireflux surgery. At the time the patient is referred for surgery, the disease has often progressed to include functional and anatomic foregut alterations. Abnormalities of esophageal motility, shortening of esophageal length, and the presence of a stricture or Barrett's metaplasia are common. Antireflux surgery in this setting is particularly challenging, and when the abnormalities are not adjusted for, the results can be less than ideal. These facts are particularly important in the era of laparoscopic fundoplication. The desire to perform a minimally invasive procedure must not foster disregard for objective confirmation of the diagnosis, careful performance of the appropriate antireflux procedure, and detection of abnormalities associated with advanced disease.