DOI: http://dx.doi.org/10.18203/2349-2902.isj20185481

Perioperative manometric studies in laparoscopic Watson’s repair versus Nissen’s fundoplication

Moharam Abdelshahid, Mohammed Sabry Ammar, Mohammed Nazeeh SH. Nassar

Abstract


Background: Hiatus Hernia (HH) and GERD are common upper gastroesophageal disorders, The Nissen`s fundoplication is one of the most effective and commonly used surgical techniques in management of both GERD and hiatus hernia (HH). many surgeons are searching for alternative procedures due to the mechanical obstructive effects of Nissen's fundoplication, one of these procedures is partial anterior fundoplication (Watson’s repair).

Methods: Eighty two patients, diagnosed to have GERD and/or HH, were scheduled for present study for laparoscopic anti-reflux surgery. They were randomized to either Watson’s repair (anterior partial fundoplication) (group I) or Nissen repair (group II) in the period between June 2012 and March 2017. Forty two patients for group I and forty patients were included in group II. Group I had partial anterior fundoplication and group II had Nissen's fundoplication. Follow up for all patients included in our study was scheduled at (2, 4weeks and 3, 6, 12months postoperatively) both subjectively - using a standardized scoring system for reflux symptoms (heartburn, regurgitation and dysphagia), gas bloating and objectively-using esophago-gastroscopy at 6ms and 12ms postoperatively, esophageal manometry, 24hours PH monitoring at 6ms and 12ms post operatively.

Results: Three cases were excluded from the study because they were converted to open procedure, one of group I and two of group II. Mean operative time was significantly shorter in group I. As regarding to reflux symptoms (heartburn and regurgitation) Nissen was significantly higher in control of reflux symptoms at 3months but at 6, 12months Nissen still higher but without a clear significant difference. On the opposite side dysphagia was significantly higher in Nissen group than in Watson group at 3months and remained higher at 6,12months but with no significant difference, also gas related symptoms were higher in Nissen group than in Watson group all the time of follow up. Objectively, esophagitis improved to a similar extent in both groups. Watson was less effective in improving LES characters, and 24hours PH parameters in comparison to Nissen group but without any significant difference in both groups.

Conclusions: Partial anterior fundoplication (Watson repair) can be safe, effective and simple alternative procedure for Nissen's fundoplication with less obstructive symptoms and complications.


Keywords


Gastroesophageal reflux, Nissen’s, Watson’s repair

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References


Ierardi E, Rosania R, Zotti M, Principe S, Laonigro G, Giorgio F, et al. Metabolic syndrome and gastro-esophageal reflux: a link towards a growing interest in developed countries. World J Gastrointestinal Pathophysiol. 2010 Aug 15;1(3):91.

Chin KF, Myers JC, Jamieson GG, Devitt PG. Symptoms experienced during 24-h pH monitoring and their relationship to outcome after laparoscopic total fundoplication. Dis Esophagus. 2008 Aug 1;21(5):445-51.

Kahrilas PJ, Shaheen NJ, Vaezi M. AGAI Medical Position Panel on GERD management. AGAI medical position statement: management of gastroesophageal reflux disease. Gastroenterol. 2008;135:1383-91.

Fock KM, Poh CH. Gastroesophageal reflux disease. J Gastroenterol. 2010 Aug 1;45(8):808-15.

Richter JE. Gastroesophageal reflux disease. In: Textbook of Gastroenterology. 5th ed. Edited by Yamada T, Blackwell Publishing. 2009:735-820.

Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, et al. Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the Esophageal Diagnostic Advisory Panel. J Am Coll Surg. 2013 Oct 1;217(4):586-97.

Christian DJ, Buyske J. Current status of antireflux surgery. Surg Clini. 2005 Oct 1;85(5):931-47.

Huttl TP, Hohle M, Meyer G, Schildberg FW. Antireflux surgery in Germany. Results of a representative survey with analysis of 2,540 antireflux operations. Chirurg. 2002;73(5):451-61.

Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M, et al. International Society for Diseases of the Esophagus-Australasian Section. Multicenter, prospective, double-blind, randomized trial of laparoscopic Nissen vs anterior 90 degrees partial fundoplication. Arch Surg. 2004 Nov;139(11):1160-7.

Ragunath K, Williams JG. A review of oesophageal manometry testing in a district general hospital. Postgrad Med J. 2002 Jan 1;78(915):34-6.

Bodger K, Trudgill N. Guidelines for oesophageal manometry and pH monitoring. London: Br Soc Gastroenterol. 2006 Nov 11.

Geoferry CW and Jacoby HI. Gastroesophageal Reflux Disease. Am J Pharm Edu. 2003;66:148-52.

Coll J.R. (2000): Laparoscopic anterior fundoplication. Surg Edin b, 2000;45:93-8.

Landreneau RJ, Wiechmann RJ, Hazelrigg SR, Santucci TS, Boley TM, Magee MJ, et al. Success of laparoscopic fundoplication for gastroesophageal reflux disease1. Ann Thoracic Surgery. 1998 Dec 1;66(6):1886-92.

Hagedorn C, Jönson C, Lönroth H, Ruth M, Thune A, Lundell L. Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial. Ann Surg. 2003 Aug;238(2):189.

Kneist W, Heintz A, Trinh TT, Junginger T. Anterior partial fundoplication for gastroesophageal reflux disease. Langenbecks Arch Surg. 2003;388:174-80.

Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG. Prospective randomized double‐blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg. 1999 Jan 1;86(1):123-30.

Chrysos E, Tzortzinis A, Tsiaoussis J, Athanasakis H, Vasssilakis JS, Xynos E. Prospective randomized trial comparing Nissen to Nissen-Rossetti technique for laparoscopic fundoplication. Am J Surg. 2001 Sep 1;182(3):215-21.

Jeffery PH, DeMeester TR, Crookes P, Oberg S, VosShoop M, Hagen JA, et al, The treatment of Gastroesophageal reflux disease with laparoscopic Nissen Fundoplication. Ann Surg. 1998:40-49.

Baigrie RJ, Cullis SN, Ndhluni AJ, Cariem A. Randomized double‐blind trial of laparoscopic Nissen fundoplication versus anterior partial fundoplication. Br J Surg. 2005 Jul;92(7):819-23.

Nijjar RS, Watson D. for the International Society fort the Diseases of the Esophagus-Australasian Section. Five-Year follow-up of a multicenter, double-blind randomized clinical trial of laparoscopic Noissen vs. anterior 90 partial fundoplication. Arch Surg. 2010;145(6):552-7.

Ma S, Qian B, Shang L, Shi R, Zhang G. A meta‐analysis comparing laparoscopic partial versus Nissen fundoplication. ANZ J Surg. 2012 Jan;82(1‐2):17-22.

Broeders JA, Roks DJ, Ali UA, Watson DI, Baigrie RJ, Cao Z, et al. Laparoscopic anterior 180-degree versus Nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg. 2013 May 1;257(5):850-9.

Watson A, Spychal RT, Brown MG, Peck N, Callander N. Laparoscopic ‘physiological’ antireflux procedure: preliminary results of a prospective symptomatic and objective study. Br J Surg. 1995 May;82(5):651-6.

Watson A. Pathophysiology of Gastroesophegeal reflux disease. in Recent Advances in surgery, Johnson CD, Taylor I, eds. London-Southhampton; 1998:159.

Watson DI, Devitt PG, Smith L, Jamieson GG. Anterior 90° partial vs Nissen fundoplication-5year follow-up of a single-centre randomised trial. J Gastrointestinal Surg. 2012 Sep 1;16(9):1653-8.