Faculty Collaboration Database

Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication. J Gastrointest Surg 2006 Jan;10(1):12-21

Date

12/22/2005

Pubmed ID

16368486

DOI

10.1016/j.gassur.2005.10.011

Scopus ID

2-s2.0-29244473146 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

An important limitation of antireflux surgery is a 5%-10% failure rate. We investigated the correlation between various diaphragm stressors and failure of antireflux surgery. Forty-one study cases who underwent a reoperative antireflux operation from 1997 to 2001 and 50 control patients who had undergone a successful laparoscopic Nissen fundoplication during the same period without clinical or symptomatic evidence of failure were randomly selected for comparison. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire, addressing the period between the primary and secondary operation. Stressors considered in the study included height, body mass index (BMI), postoperative gagging, vomiting, weight lifting (greater than 100 pounds), coughing, hiccuping, motion sickness, retching, belching, antidepressant use, smoking, preoperative grade of esophagitis, size of hiatal hernia, lower esophageal sphincter pressure, esophageal body pressures, and preoperative response to proton pump inhibitors. Of the potential stressors investigated, the following were significantly associated with surgical failure after adjusting for other variables through multivariate analysis: gagging (P = 0.005), belching (P = 0.02), and hernia size greater than 3 cm (P = 0.04; Table 1). Other potential risk factors show trends as obvious in Fig. 2. Vomiting was significant (P = 0.01) in the earlier models but lost significance when logistic regression was applied. Patients with postoperative gagging and an intraoperative hiatal hernia (greater than 3 cm) have a poorer outcome, whereas patients with postoperative belching have a better long-term outcome.

Author List

Iqbal A, Kakarlapudi GV, Awad ZT, Haynatzki G, Turaga KK, Karu A, Fritz K, Haider M, Mittal SK, Filipi CJ

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Antidepressive Agents
Body Height
Body Mass Index
Case-Control Studies
Cough
Diaphragm
Eructation
Esophagitis
Female
Follow-Up Studies
Fundoplication
Gagging
Gastroesophageal Reflux
Hernia, Hiatal
Hiccup
Humans
Laparoscopy
Male
Middle Aged
Motion Sickness
Postoperative Nausea and Vomiting
Retrospective Studies
Risk Factors
Smoking
Treatment Failure