Table Of ContentLaparoscopic
Antireflux
Surgery
Sungsoo Park
Miguel Burch
Joong-Min Park
Editors
123
Laparoscopic Antireflux Surgery
Sungsoo Park • Miguel Burch
Joong-Min Park
Editors
Laparoscopic Antireflux
Surgery
Editors
Sungsoo Park Miguel Burch
Department of Surgery Department of Surgery
Korea University Medical Center Cedars Sinai Medical Center
Seoul, Korea (Republic of) Los Angeles, CA, USA
Joong-Min Park
Department of Surgery
Chung-Ang University Gwangmyeong
Hospital
Gwangmyeong, Korea (Republic of)
ISBN 978-981-19-7172-3 ISBN 978-981-19-7173-0 (eBook)
https://doi.org/10.1007/978-981-19-7173-0
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Singapore Pte Ltd. 2023
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Acknowledgements
Although our names appear as the book authors, this book has been the result
of the work of a large team who not only contributed some of the individual
chapters but helped with their editing, organization and checked their facts
and figures. We are naming them below:
Ahmad Salem Nammour Alromi, Jordanian Board of General Surgery,
Ministry of Health Jordan, Jordan—contributed in checking of spelling
errors, figures, tables and references in whole book and literature search
Without him, we would not have been able to complete this large book and
we are deeply grateful for all the help they have given us.
v
Contents
1 The Chronicle of Antireflux Surgery. . . . . . . . . . . . . . . . . . . . . . . 1
Sang-Yong Son, Shin-Hoo Park, and Sang-Uk Han
2 GERD Pathogenesis and Essential Anatomic
Knowledge for Antireflux Surgery . . . . . . . . . . . . . . . . . . . . . . . . 7
Jin-Jo Kim
3 Clinical Manifestations and Surgical Indications of
Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . . . . . . . . 15
Joong-Min Park and Sungsoo Park
4 Anti-reflux Surgery to Extra- esophageal
Manifestations of GERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Yosuke Seki
5 Diagnostic Tests and Interpretations Before
Anti- reflux Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Beom Jin Kim
6 Various Techniques of Anti-reflux Treatment . . . . . . . . . . . . . . . 51
George Tadros, Sinal Patel, Emanuele Lo Menzo,
Samuel Szomstein, and Raul Rosenthal
7 Postoperative Clinical Pathway After Anti-reflux Surgery . . . . . 63
Dong-Wook Kim and Jeong Goo Kim
8 Complications After Antireflux Surgery (ARS)
and Managements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Kyo Young Song
9 Long-Term Outcomes and Cost- Effectiveness
of Anti-reflux Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Kyung Won Seo
10 Failure and Revision of Antireflux Surgery . . . . . . . . . . . . . . . . . 79
Joshua Tseng and Miguel Burch
11 Anti-reflux Surgery During Specific Situations:
Achalasia, Para- esophageal Large Hiatal Hernia . . . . . . . . . . . . 87
Won Jun Seo and Jong-Han Kim
vii
viii Contents
12 Reflux After Bariatric Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Allison M. Barrett
13 Emerging Surgical Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Joshua Tseng and Miguel Burch
1
The Chronicle of Antireflux
Surgery
Sang-Yong Son, Shin-Hoo Park, and Sang-Uk Han
Abstract (Schlottmann et al. World J, Surg. 42:2183–
2189, 2018). Of 96,702 elective procedures
Antireflux surgery is an effective treatment
conducted between 2005 and 2010, 81.6%
option for patients with gastroesophageal
were laparoscopic fundoplication, and 18.4%
reflux disease (GERD) who respond inade-
were an open procedure (Funk et al. Surg
quately to medical therapy, want to avoid life-
Endosc. 28:1712–9, 2014)
long medication use, or have significant
complications such as Barrett’s esophagus or
Keywords
stricture due to acid reflux. Antireflux surgery
is a commonly performed procedure in the History · Gastroesophageal reflux · Surgery
United States. The number of antireflux sur-
geries increased from 9173 in 1993 to
32,980 in 2000 but steadily declined to 1.1 H istorical Trends
19,668 in 2006, possibly due to the develop- of Antireflux Surgery
ment of proton pump inhibitor (PPI) therapy
and the popularity of laparoscopic bariatric 1.1.1 I nitiation of Antireflux
surgery (Wang et al. Dis Esophagus. 24:215– Surgery
23, 2011). According to the National Inpatient
Sample database of the United States, 83.1%, A schematic of trends of antireflux surgery is
11.6%, and 5.3% of patients underwent antire- provided in Fig. 1.1. Surgical management of
flux surgery in high-volume centers (>25 oper- GERD was associated with esophagitis and a hia-
ations/year), intermediate-volume hospitals tal hernia (HH) for a long time [4]. Esophagitis
(10–25 operations/year), and low-volume hos- was first described by Quincke in 1859 [5], and
pitals (<10 operations/year), respectively peptic esophagitis was proposed as a new clinical
entity by Winkelstein in 1935 [6]. A postmortem
description of diaphragmatic hernias was first
S.-Y. Son · S.-U. Han (*) written by Morgagni in 1769. Eppinger diag-
Department of Surgery, Ajou University School of nosed the first HH in a living patient, and Mayo
Medicine, Suwon, Gyeonggi-do, South Korea
performed the first operation for this condition in
e-mail: [email protected]
1909 [7].
S.-H. Park
Division of Foregut Surgery, Department of Surgery,
Korea University College of Medicine,
Seoul, Republic of Korea
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 1
S. Park et al. (eds.), Laparoscopic Antireflux Surgery, https://doi.org/10.1007/978-981-19-7173-0_1
2 S.-Y. Son et al.
Fig. 1.1 Evolution of antireflux surgery for the treatment of GERD
1.2 C oncept of His Angle 1.3 E sophageal Lengthening
Procedure
Therapy for GERD initially involved reposition-
ing the stomach to the abdomen and repairing The length of the abdominal portion of the esoph-
and tightening the esophageal hiatus. Philip agus is important for a natural antireflux mecha-
Rowland Allison, a British surgeon, initiated the nism. Historically, the length of the abdominal
modern era of antireflux surgery. In 1951, he esophagus was a concern because of the need to
published a series of patients in whom the stom- reposition the herniated stomach and the possi-
ach was repositioned to the abdomen, and crural bility of the esophagus being short [17]. A tech-
fibers were closed behind the esophagus [8]. He nique to lengthen the esophagus for treatment of
believed that these fibers function as a pinchcock GERD was first described by John Collis, an
to prevent reflux. He achieved good results, with English surgeon, in 1957 [18]. Collis performed
symptoms relieved in more than 80% of patients an esophageal-lengthening procedure via a left
after 20 years and 49% of patients with radio- thoracoabdominal incision. Because Collis
logic recurrence of the hernia [9]. It was subse- believed that “the acute angle of implantation of
quently acknowledged that GERD can develop the esophagus into the stomach which in turn is
without an associated HH. After introduction of produced by the normally functioning crural
the Allison procedure, it became clear that fixing muscle…was the one which could be effective
the HH and performing hiatoplasty are essential alone”, he created a narrow, somewhat distally
for surgical treatment of GERD [10–12]. tapered tube along the proximal lesser curvature
Meanwhile, Norman Rupert Barrett, a famous of the stomach. Although seven of eight patients
surgeon after whom Barrett’s esophagus is who underwent Collis gastroplasty had excellent
named, pioneered the idea that restoring the car- results, all had dysphagia for weeks to several
dioesophageal angle (or His angle) is critical to months postoperatively. However, the 1957
prevent reflux [13]. Subsequent studies showed Collis gastroplasty by itself did not prove to
that fundoplication performed ex vivo on human entirely control reflux esophagitis at that time.
stomachs prevents reflux to the point of gastric Pearson and associates of Toronto deserve credit
explosion, probably by accentuating the His for combining the Collis gastroplasty with the
angle [14, 15]. However, restoration of an acute Belsey procedure (stomach partially wrapped
His angle alone does not achieve as good physi- around the esophagus all anchored beneath the
ologic or clinical outcomes as those in patients diaphragm), which made the gastroplasty more
who undergo Lortat-Jacob antireflux repair [16]. effective antireflux operation [19, 20]. Orringer
1 The Chronicle of Antireflux Surgery 3
and Sloan of Ann Arbor changed the Collis- that should be applied close-fitting to the esopha-
Belsey procedure to the Collis-Nissen procedure gogastric junction. Other modifications of the
and reported excellent results [21, 22]. Today, original technique were also developed, such as
this has evolved into numerous procedural varia- use of a calibrating intraesophageal bougie to
tions with the advent of minimally invasive sur- perform fundoplication, short gastric vessel divi-
gery and surgical staplers. sion, and anchoring of the fundoplication on the
hiatus [29]. In 1991, the first laparoscopic Nissen
fundoplication was reported by Bernard
1.4 The Advent Dallemagne [30]. The laparoscopic approach
of Fundoplication reduces postoperative pain, shortens hospitaliza-
tion and recuperation, and achieves similar func-
Rudolf Nissen, a famous German surgeon, devel- tional outcomes compared with an open approach.
oped the most successful and widely used surgi- At 5 years, 93% of the patients were free of sig-
cal therapy for GERD, called fundoplication, in nificant reflux symptoms and 89.5% still at
1956 [23]. This procedure plicates the fundus of 10 years after surgery [31]. Owing to these
the stomach around the distal esophagus 360° advantages, laparoscopic Nissen fundoplication
circumferentially. Nissen’s fundoplication has rapidly gained popularity and been accepted
became popular but was frequently associated as the current gold standard for surgical treatment
with dysphagia, bloating, and inability to belch, of GERD.
the so-called gas-bloat syndrome [17]. To reduce
these side effects, it has evolved with several
modifications. Andre Toupet introduced his par- 1.5 M odern Alternative Efforts
tial posterior (270°) fundoplication in 1963, with to Improve Antireflux
the aim of inducing less narrowing and therefore Surgery
less dysphagia by repositioning the lower esoph-
agus into the abdominal cavity, reconstructing Angelchik and Cohen attempted to reinforce the
the His angle, and preventing cardia migration LES with a silicon ring prosthesis around the
[24]. However, his original technique did not esophagogastric junction in 1979 [32]. This pro-
close the hiatus. In addition, he did not divide the cedure gained great popularity with over 25,000
short gastric vessels but mobilize the posterior implants performed; however, a foreign sub-
wall of the fundus extensively. In 1967, Belsey stance at the level of the esophagogastric junction
and Hill followed a semi-fundoplicative maneu- induced poor outcomes and many severe compli-
ver, with restoring the normal physiology of the cations related to unmanageable dysphagia and
lower esophageal sphincter (LES) [25, 26]. erosion or migration of the prosthesis [33–36].
Thereafter, other partial fundoplication proce- Fortunately, this device is not currently in use. A
dures were developed and became known as magnetic sphincter augmentation device was first
Guarner posterior fundoplasty [27]. In this pro- used in an attempt to reinforce the LES with a
cedure, the fundus of the stomach was passed string of magnetic beads surrounding the esopha-
behind the esophagus, thus forming between the gogastric junction in 2007 [37]. With each peri-
esophagus and right aspect of the fundus as a staltic swallow, the individual beads separate,
120° angle, and division of the short gastric ves- allowing the magnetic and active sphincter to
sels was not required. Another important modifi- open and a food bolus to pass; after passage of a
cation was loosening of the wrap and reducing bolus, the beads reapproximate and augment the
the size of the valve, the so-called “short-floppy” closure of the sphincter. This LES augmentation
Nissen. The first technique was developed by procedure controlled reflux in 72% of patients in
Donahue to avoid gaseous eructation and vomit- a large multicenter study [38]. However, the rate
ing [28]. This technique revoked the theory that of procedure-related adverse events was 11.6% in
fundoplication works solely as a pneumatic valve the long term: 9.2% of patients required device
