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Jari Ovaska - One of the best experts on this subject based on the ideXlab platform.
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fifteen year outcome of laparoscopic and open Nissen Fundoplication a randomized clinical trial
The Annals of Thoracic Surgery, 2012Co-Authors: Paulina Salminen, Saija Hurme, Jari OvaskaAbstract:Background Laparoscopic Nissen Fundoplication (LNF) has become the method of choice in the surgical treatment of gastroesophageal reflux disease (GERD), replacing its open counterpart without confirmation by the long-term results of controlled clinical studies. The goal of the present study was to compare the 15-year outcome of a randomized controlled comparison study of LNF versus open Nissen Fundoplication (ONF). Methods From 1992 to 1995, 110 consecutive patients were randomized to undergo LNF or ONF. The 15-year objective results were evaluated by endoscopy, and the subjective symptomatic outcome was assessed by interviews. Results A total of 86 patients (48 in the LNF [LAP] and 38 in the ONF [OPEN] group) participated in the study. The late long-term symptomatic outcome was similar in the two patient groups. In the LAP group, 91.7% of the patients gave a positive evaluation of their surgical result, as compared with 76.3% of the patients in the OPEN group ( p = 0.0484). A significantly greater number of disrupted plications ( p = 0.0115) and incisional hernias ( p p = 0.0851) an increasing need for the regular use of a proton pump inhibitor with the passage of time after Nissen Fundoplication. Conclusions The 15-year results obtained in the present study define laparoscopic Nissen Fundoplication as the procedure of choice in the surgical management of GERD. The long-term symptomatic outcomes of open and laparoscopic Nissen Fundoplication appear to remain unaltered after the first 10 postoperative years.
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Immune response after laparoscopic and conventional Nissen Fundoplication.
The European journal of surgery = Acta chirurgica, 1999Co-Authors: J. Perttilä, Jari Ovaska, Matti Salo, Juha M. Grönroos, M. Lavonius, Ari Katila, M. Lähteenmäki, Kari PulkkiAbstract:Objective: To compare the changes in the immune responses of patients undergoing laparoscopic or conventional Nissen Fundoplication.Design: Prospective randomised clinical study.Setting: University hospital, Finland.Subjects: 20 patients undergoing Nissen Fundoplication for symptomatic erosive oesophagitis.Intervention: Laparoscopic Nissen Fundoplication (n ≥ 10) or conventional open Nissen Fundoplication (n ≥ 10).Main outcome measures: Leucocyte and differential counts; percentages of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD20 positive lymphocytes); and monocytes (CD14); phytohemagglutinin, concanavalin A and pokeweed mitogen-induced and unstimulated proliferation of separated lymphocytes; plasma interleukin-6 (IL-6), serum C-reactive protein (CRP), albumin, and cortisol concentrations; and group II phospholipase A2 (PLA2) activity.Results: Laparoscopic Fundoplication was associated with less tissue damage (IL-6, and CRP concentrations) than the conventional open operation. However, although...
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Laparoscopic vs conventional Nissen Fundoplication : A prospective randomized study
Surgical endoscopy, 1997Co-Authors: S. Laine, Rantala A, Risto Gullichsen, Jari OvaskaAbstract:Background: Laparoscopic Nissen Fundoplication has gained wide acceptance among surgeons, but the results of the laparoscopic procedure have not been compared to the results of an open Fundoplication in a randomized study.
David I. Watson - One of the best experts on this subject based on the ideXlab platform.
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five year outcome after laparoscopic anterior partial versus Nissen Fundoplication four randomized trials
Annals of Surgery, 2012Co-Authors: Joris A Broeders, R. J. Baigrie, Glyn G. Jamieson, David J Roks, Peter G Devitt, David I. WatsonAbstract:Objective:To compare longer term (5-year) outcomes for reflux control and postsurgery side effects after laparoscopic anterior (90° and 180°) partial versus Nissen Fundoplication for gastroesophageal reflux.Background:Laparoscopic Nissen Fundoplication is the most frequently performed surgical proce
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laparoscopic Nissen Fundoplication five year results and beyond
Archives of Surgery, 2001Co-Authors: Thiery Lafullarde, David I. Watson, Jennifer C. Myers, Glyn G. Jamieson, Philip A Game, Peter G DevittAbstract:Hypothesis Laparoscopic Nissen Fundoplication provides long-term relief of symptoms of gastroesophageal reflux disease. Design Prospectively evaluated case series. Setting University teaching hospital. Patients From September 1991 to December 1999, we performed more than 900 laparoscopic antireflux procedures. The outcome for patients who underwent surgery between September 1991 and June 1994 (178 cases) was determined. This included all patients having laparoscopic Nissen Fundoplication, from the first procedure onward. Interventions Long-term follow-up for 5 or more years after laparoscopic Nissen Fundoplication was obtained by an independent investigator who interviewed patients using a structured questionnaire. Main Outcome Measures Prospective evaluation of clinical symptoms using a structured questionnaire. Results Outcome data covering a period of 5 or more years after surgery was available for 176 patients (99%), with 2 patients lost to follow-up. Nine patients died (8 of unrelated causes) at some stage following surgery, and the outcome was difficult to determine in 1 patient with cerebral palsy. Hence, questionnaire data were available for 166 patients at a median follow-up of 6 years (range, 5-8 years). Three patients (1.7%) underwent revision surgery for recurrent reflux; 87% of the 176 patients remained free of significant reflux. Reoperation was required for dysphagia in 7 patients (3.9%), 2 for a tight wrap and 5 for a tight diaphragmatic hiatus. In addition, reoperation was necessary for a paraesophageal hiatus hernia in 13 patients (7.3%). Of the reoperations, 56% were performed within 12 months of the original procedure, and 22% during the second year of follow-up. Further surgery was uncommon after 2 years. The long-term outcome was considered "good or excellent" by 90% of patients. Conclusions The long-term outcome of laparoscopic Nissen Fundoplication is similar to that following open Fundoplication. Good results are obtained in most patients.
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Outcome of laparoscopic Nissen Fundoplication in patients with disordered preoperative peristalsis.
Gut, 1997Co-Authors: R. J. Baigrie, David I. Watson, Jennifer C. Myers, Glyn G. JamiesonAbstract:BACKGROUND: A 360 degrees or Nissen Fundoplication remains controversial in patients with disordered peristalsis, some surgeons preferring a partial wrap to minimise postoperative dysphagia. AIM: To evaluate symptoms and manometric outcome in patients with disordered peristalsis after Nissen Fundoplication. PATIENTS: In an initial series of 345 patients studied prospectively, 31 patients who had undergone a Nissen Fundoplication had disordered peristalsis. Using preoperative manometry, patients were classified as: equivocal primary peristalsis (eight patients); abnormal primary peristalsis (four patients); abnormal maximal contraction pressure (13 patients); abnormal primary peristalsis and maximal contraction pressure (six patients). METHODS: Postoperatively, patients underwent a barium meal, oesophageal manometry and standardised clinical review by a blinded scientific officer. RESULTS: Twenty eight (90%) patients had satisfaction scores of at least 8 out of a maximum of 10 and all would undergo surgery again. Whereas 15 (48%) patients had dysphagia scores greater than 4/10 preoperatively, only two (6%) had these scores at one year. Improved peristalsis was seen in 78% of postoperative manometric studies, and mean preoperative lower oesophageal sphincter pressure increased from 6.6 (range 0-21) mm Hg to 19 (4-50) mm Hg. CONCLUSIONS: These results are similar to the overall group of 345 patients and suggest that disordered peristalsis, and possibly even absent peristalsis, is not a contraindication to Nissen Fundoplication as performed in these patients.
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Simulated laparoscopic Nissen Fundoplication
Minimally Invasive Therapy, 1994Co-Authors: David I. Watson, A. W. Majeed, Alan G. JohnsonAbstract:SummaryA simulator enabling a laparoscopic Nissen Fundoplication to be practised is described. It utilizes a frame and pig viscera, providing an inexpensive means of practising the laparoscopic dissection and suturing skills required for laparoscopic Fundoplication.
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Laparoscopic Nissen Fundoplication.
Annals of surgery, 1994Co-Authors: Glyn G. Jamieson, David I. Watson, R. Britten‐jones, Phlip C. Mitchell, Mehran AnvariAbstract:Operations which alter gastrointestinal function, but which do not require the removal of an organ or part of an organ, seem ideally suited to being undertaken laparoscopically. Fundoplication falls firmly into this category. The procedure was first reported in 1991 by Dallemagne who divided the short gastric vessels in performing the technique. The authors feel justified in calling their technique a Nissen Fundoplication, as the anterior wall of the stomach is used without dividing the short gastric vessels as first described by Nissen.
Evaghelos Xynos - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic vs open approach for Nissen Fundoplication
Surgical endoscopy, 2002Co-Authors: Emmanuel Chrysos, John Tsiaoussis, Elias Athanasakis, Odysseus John Zoras, John Sophocles Vassilakis, Evaghelos XynosAbstract:Background: Several studies, most of them nonrandomized, have shown similar functional results for both laparoscopic and open Nissen Fundoplication, the operation of choice for the treatment of gastroesophageal reflux disease (GERD). Methods: A total of 106 patients with documented GERD were randomized to receive either a laparoscopic or an open Nissen Fundoplication. Preoperative and postoperative investigations included clinical assessment, esophagogram, upper gastrointestinal endoscopy, esophageal manometry, and 24-h ambulatory pHmetry. Results: Both approaches were successful in controlling reflux. There was an overall improvement in esophageal peristalsis and an increase in lower esophageal sphincter (LES) pressure in both groups. Open Nissen Fundoplication was associated with a significantly increased rate of wound (p
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laparoscopic vs open approach for Nissen Fundoplication
Surgical Endoscopy and Other Interventional Techniques, 2002Co-Authors: Emmanuel Chrysos, John Tsiaoussis, Elias Athanasakis, Odysseus John Zoras, John Sophocles Vassilakis, Evaghelos XynosAbstract:Background: Several studies, most of them nonrandomized, have shown similar functional results for both laparoscopic and open Nissen Fundoplication, the operation of choice for the treatment of gastroesophageal reflux disease (GERD). Methods: A total of 106 patients with documented GERD were randomized to receive either a laparoscopic or an open Nissen Fundoplication. Preoperative and postoperative investigations included clinical assessment, esophagogram, upper gastrointestinal endoscopy, esophageal manometry, and 24-h ambulatory pHmetry. Results: Both approaches were successful in controlling reflux. There was an overall improvement in esophageal peristalsis and an increase in lower esophageal sphincter (LES) pressure in both groups. Open Nissen Fundoplication was associated with a significantly increased rate of wound (p <0.001) and respiratory (p <0.05) complications. Hospitalization was also longer after the open technique (p <0.001). At 3-month follow-up, although the rate of postoperative dysphagia was similar for the two approaches, the open approach was associated with a significantly higher incidence of postprandial epigastric fullness (p <0.05) and bloating syndrome (p <0.01). Conclusions: The open and laparoscopic approaches for the Nissen Fundoplication are equally effective in controlling GERD. The open approach is associated with a significantly higher rate of wound and respiratory complications and, at early stages, an increased rate of postprandial epigastric fullness and abdominal bloating. The dysphagia rate is similar with both methods.
Glyn G. Jamieson - One of the best experts on this subject based on the ideXlab platform.
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five year outcome after laparoscopic anterior partial versus Nissen Fundoplication four randomized trials
Annals of Surgery, 2012Co-Authors: Joris A Broeders, R. J. Baigrie, Glyn G. Jamieson, David J Roks, Peter G Devitt, David I. WatsonAbstract:Objective:To compare longer term (5-year) outcomes for reflux control and postsurgery side effects after laparoscopic anterior (90° and 180°) partial versus Nissen Fundoplication for gastroesophageal reflux.Background:Laparoscopic Nissen Fundoplication is the most frequently performed surgical proce
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laparoscopic Nissen Fundoplication five year results and beyond
Archives of Surgery, 2001Co-Authors: Thiery Lafullarde, David I. Watson, Jennifer C. Myers, Glyn G. Jamieson, Philip A Game, Peter G DevittAbstract:Hypothesis Laparoscopic Nissen Fundoplication provides long-term relief of symptoms of gastroesophageal reflux disease. Design Prospectively evaluated case series. Setting University teaching hospital. Patients From September 1991 to December 1999, we performed more than 900 laparoscopic antireflux procedures. The outcome for patients who underwent surgery between September 1991 and June 1994 (178 cases) was determined. This included all patients having laparoscopic Nissen Fundoplication, from the first procedure onward. Interventions Long-term follow-up for 5 or more years after laparoscopic Nissen Fundoplication was obtained by an independent investigator who interviewed patients using a structured questionnaire. Main Outcome Measures Prospective evaluation of clinical symptoms using a structured questionnaire. Results Outcome data covering a period of 5 or more years after surgery was available for 176 patients (99%), with 2 patients lost to follow-up. Nine patients died (8 of unrelated causes) at some stage following surgery, and the outcome was difficult to determine in 1 patient with cerebral palsy. Hence, questionnaire data were available for 166 patients at a median follow-up of 6 years (range, 5-8 years). Three patients (1.7%) underwent revision surgery for recurrent reflux; 87% of the 176 patients remained free of significant reflux. Reoperation was required for dysphagia in 7 patients (3.9%), 2 for a tight wrap and 5 for a tight diaphragmatic hiatus. In addition, reoperation was necessary for a paraesophageal hiatus hernia in 13 patients (7.3%). Of the reoperations, 56% were performed within 12 months of the original procedure, and 22% during the second year of follow-up. Further surgery was uncommon after 2 years. The long-term outcome was considered "good or excellent" by 90% of patients. Conclusions The long-term outcome of laparoscopic Nissen Fundoplication is similar to that following open Fundoplication. Good results are obtained in most patients.
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Outcome of laparoscopic Nissen Fundoplication in patients with disordered preoperative peristalsis.
Gut, 1997Co-Authors: R. J. Baigrie, David I. Watson, Jennifer C. Myers, Glyn G. JamiesonAbstract:BACKGROUND: A 360 degrees or Nissen Fundoplication remains controversial in patients with disordered peristalsis, some surgeons preferring a partial wrap to minimise postoperative dysphagia. AIM: To evaluate symptoms and manometric outcome in patients with disordered peristalsis after Nissen Fundoplication. PATIENTS: In an initial series of 345 patients studied prospectively, 31 patients who had undergone a Nissen Fundoplication had disordered peristalsis. Using preoperative manometry, patients were classified as: equivocal primary peristalsis (eight patients); abnormal primary peristalsis (four patients); abnormal maximal contraction pressure (13 patients); abnormal primary peristalsis and maximal contraction pressure (six patients). METHODS: Postoperatively, patients underwent a barium meal, oesophageal manometry and standardised clinical review by a blinded scientific officer. RESULTS: Twenty eight (90%) patients had satisfaction scores of at least 8 out of a maximum of 10 and all would undergo surgery again. Whereas 15 (48%) patients had dysphagia scores greater than 4/10 preoperatively, only two (6%) had these scores at one year. Improved peristalsis was seen in 78% of postoperative manometric studies, and mean preoperative lower oesophageal sphincter pressure increased from 6.6 (range 0-21) mm Hg to 19 (4-50) mm Hg. CONCLUSIONS: These results are similar to the overall group of 345 patients and suggest that disordered peristalsis, and possibly even absent peristalsis, is not a contraindication to Nissen Fundoplication as performed in these patients.
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Laparoscopic Nissen Fundoplication.
Annals of surgery, 1994Co-Authors: Glyn G. Jamieson, David I. Watson, R. Britten‐jones, Phlip C. Mitchell, Mehran AnvariAbstract:Operations which alter gastrointestinal function, but which do not require the removal of an organ or part of an organ, seem ideally suited to being undertaken laparoscopically. Fundoplication falls firmly into this category. The procedure was first reported in 1991 by Dallemagne who divided the short gastric vessels in performing the technique. The authors feel justified in calling their technique a Nissen Fundoplication, as the anterior wall of the stomach is used without dividing the short gastric vessels as first described by Nissen.
Peter G Devitt - One of the best experts on this subject based on the ideXlab platform.
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five year outcome after laparoscopic anterior partial versus Nissen Fundoplication four randomized trials
Annals of Surgery, 2012Co-Authors: Joris A Broeders, R. J. Baigrie, Glyn G. Jamieson, David J Roks, Peter G Devitt, David I. WatsonAbstract:Objective:To compare longer term (5-year) outcomes for reflux control and postsurgery side effects after laparoscopic anterior (90° and 180°) partial versus Nissen Fundoplication for gastroesophageal reflux.Background:Laparoscopic Nissen Fundoplication is the most frequently performed surgical proce
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laparoscopic Nissen Fundoplication five year results and beyond
Archives of Surgery, 2001Co-Authors: Thiery Lafullarde, David I. Watson, Jennifer C. Myers, Glyn G. Jamieson, Philip A Game, Peter G DevittAbstract:Hypothesis Laparoscopic Nissen Fundoplication provides long-term relief of symptoms of gastroesophageal reflux disease. Design Prospectively evaluated case series. Setting University teaching hospital. Patients From September 1991 to December 1999, we performed more than 900 laparoscopic antireflux procedures. The outcome for patients who underwent surgery between September 1991 and June 1994 (178 cases) was determined. This included all patients having laparoscopic Nissen Fundoplication, from the first procedure onward. Interventions Long-term follow-up for 5 or more years after laparoscopic Nissen Fundoplication was obtained by an independent investigator who interviewed patients using a structured questionnaire. Main Outcome Measures Prospective evaluation of clinical symptoms using a structured questionnaire. Results Outcome data covering a period of 5 or more years after surgery was available for 176 patients (99%), with 2 patients lost to follow-up. Nine patients died (8 of unrelated causes) at some stage following surgery, and the outcome was difficult to determine in 1 patient with cerebral palsy. Hence, questionnaire data were available for 166 patients at a median follow-up of 6 years (range, 5-8 years). Three patients (1.7%) underwent revision surgery for recurrent reflux; 87% of the 176 patients remained free of significant reflux. Reoperation was required for dysphagia in 7 patients (3.9%), 2 for a tight wrap and 5 for a tight diaphragmatic hiatus. In addition, reoperation was necessary for a paraesophageal hiatus hernia in 13 patients (7.3%). Of the reoperations, 56% were performed within 12 months of the original procedure, and 22% during the second year of follow-up. Further surgery was uncommon after 2 years. The long-term outcome was considered "good or excellent" by 90% of patients. Conclusions The long-term outcome of laparoscopic Nissen Fundoplication is similar to that following open Fundoplication. Good results are obtained in most patients.