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Who benefits from antireflux surgery?
1Department of Surgery, University of Southern California Medical Center, Los Angeles 90033.
World Journal of Surgery
|March 1, 1992
Summary
Accurate diagnosis of gastro-esophageal reflux disease (GERD) is crucial. Antireflux surgery is effective for patients with a mechanically defective lower esophageal sphincter, offering long-term symptom relief.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Gastro-esophageal reflux disease (GERD) requires objective diagnosis to guide therapy.
- GERD causes include a defective lower esophageal sphincter (LES), poor esophageal clearance, and gastric abnormalities.
- Antireflux surgery targets a mechanically defective LES, identified by specific pressure and length parameters.
Purpose of the Study:
- To define objective criteria for selecting patients for antireflux surgery.
- To evaluate the efficacy of Nissen fundoplication in selected GERD patients.
Main Methods:
- Assessed patients with GERD for mechanical LES defects via manometry.
- Utilized 24-hour esophageal pH monitoring to document increased acid exposure.
- Identified indications for surgery including persistent symptoms despite medical therapy and objective diagnostic findings.
Main Results:
- Approximately 50-60% of GERD patients exhibit a mechanically defective LES.
- Nissen fundoplication demonstrated a 91% success rate in symptom relief for selected patients.
- Surgery is not indicated for GERD caused by ineffective clearance or gastric issues.
Conclusions:
- Objective diagnosis, including manometry and pH monitoring, is essential for GERD management.
- Antireflux surgery, specifically Nissen fundoplication, is highly effective for GERD patients with a mechanically defective LES.
- Careful patient selection based on objective criteria ensures optimal outcomes for antireflux procedures.