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Antireflux surgery

Gatenby, PAC; Bann, SD; (2009) Antireflux surgery. MINERVA CHIR , 64 (2) 169 - 181.

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Abstract

Gastro-oesophageal reflux disease is extremely common throughout Europe and the United States. This review on antireflux surgery examines the best evidence for surgical treatment of gastro-esophageal reflux disease. Comparison is made with medical antireflux therapy including histamine H2 receptor antagonist and proton pump inhibitor therapy. The randomized trials and systematic reviews available on gastro-esophageal reflux disease are reviewed and where data are scarce, the largest cohort studies available are discussed. Overall, laparoscopic antireflux surgery is safe and has a similar efficacy to open antireflux surgery and best medical therapy with proton pump inhibitors. There is a failure rate, which in some series is greater than 30% at 5 years. Due to the cost of a proportion of patients still taking antireflux medications, it cannot be recommended on cost-effectiveness grounds over best medical therapy. The choice of procedure lies between complete wrap with Nissen's fundoplication and partial fundoplication (most frequently Toupet). Division of the short gastric vessels is not usually necessary and is associated with increased wind-related complications. Total fundoplication tends to produce superior reflux control, but at the cost of increased risk of dysphagia. There is a trend for antireflux surgery to be superior to best medical therapy in cancer prevention in Barrett's oesophagus, but this has not reached statistical significance.

Type:Article
Title:Antireflux surgery
Keywords:Gastroesophageal reflux, diagnosis, Gastroesophageal reflux, surgery, Fundoplication, Proton pump inhibitors, Barrett esophagus, Esophageal neoplasms, GASTROESOPHAGEAL-REFLUX DISEASE, LAPAROSCOPIC NISSEN FUNDOPLICATION, RANDOMIZED CLINICAL-TRIAL, PREOPERATIVE ESOPHAGEAL MOTILITY, ANTERIOR PARTIAL FUNDOPLICATION, SHORT GASTRIC VESSELS, DOUBLE-BLIND TRIAL, 5-YEAR FOLLOW-UP, BODY-MASS INDEX, BARRETTS-ESOPHAGUS
UCL classification:UCL > School of Life and Medical Sciences > Faculty of Medical Sciences > Surgery and Interventional Science (Division of)

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