Characteristics and Outcomes of Laparoscopic Surgery in Patients with Gastroesophageal Reflux and Related Disease: A Single Center Experience.
BACKGROUND
Laparoscopic anti-reflux surgery (LARS) is generally the treatment of choice for patients with gastroesophageal reflux disease (GERD). This report describes our experiences in performing LARS on patients with GERD, and focuses retrospectively on the pathophysiology of individual patients and the current status of Japanese patients who have undergone LARS. We demonstrate that patients with non-erosive reflux disease resistant to proton pump inhibitors (PPI-resistant NERD) and high-risk giant hernia, whom we are sometimes hesitant to treat surgically, can be safely and successfully treated with LARS (depending on the pathophysiology of individual patients).


METHODS
Between January 2007 and June 2015, 37 patients underwent LARS at Nippon Medical School Hospital. These patients were retrospectively subgrouped according to pathophysiology; 9 of them had PPI-resistant NERD (Group A), 19 had a giant hiatal hernia (Group B), and 9 had erosive esophagitis (Group N). Patient characteristics, intraoperative bleeding, operation duration, perioperative complications, and length of hospital stay were determined, along with symptomatic outcomes and patient satisfaction.


RESULTS
Patients in Group A were the youngest (average: 43.9 years), and those in Group B were the oldest (75.9 years) (P=0.002). The percentage of high-risk patients, as determined by performance status (P=0.047) and American Society of Anesthesiologists physical status classification (P=0.021), was highest in Group B, whereas the percentage of patients with mental disorders was highest in Group A (P=0.012). There were no significant differences among the groups in terms of intraoperative bleeding, surgery duration, or postoperative hospital stay. Thirty-three patients (89.2%), including all 19 in Group B, expressed excellent or good postoperative satisfaction levels.


CONCLUSIONS
The characteristics of the patients who underwent LARS at our hospital differed according to pathophysiology and from those in western countries. Satisfactory outcomes depended on the pathophysiology of individual patients.
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School.
Tsutomu
T
Nomura
Katsuhiko
K
Iwakiri
Takeshi
T
Matsutani
Nobutoshi
N
Hagiwara
Itsuo
I
Fujita
Yoshiharu
Y
Nakamura
Yoshikazu
Y
Kanazawa
Hiroshi
H
Makino
Noriyuki
N
Kawami
Masao
M
Miyashita
Eiji
E
Uchida
D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004941:Esophagitis / Q000601:surgery; D005260:Female; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome