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Related Experiment Videos

On-table endoscopy following laparoscopic fundoplication.

Narayanasamy Ravi1, Nael Al-Sarraf, Paul Balfe

  • 1University Department of Surgery, Trinity Centre for Health Sciences, St. James' Hospital, Dublin 8, Ireland.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|September 18, 2007
PubMed
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On-table endoscopy during laparoscopic fundoplication significantly reduces dysphagia and reinterventions for gastro-esophageal reflux disease (GERD). This quality initiative improves patient outcomes by minimizing complications after anti-reflux surgery.

Area of Science:

  • Gastroenterology and Surgical Innovation
  • Minimally Invasive Surgery Techniques

Background:

  • Laparoscopic fundoplication is the standard surgical treatment for gastro-esophageal reflux disease (GERD).
  • Minimizing postoperative dysphagia and technical errors is crucial for successful outcomes.
  • On-table endoscopy was implemented as a quality improvement measure to address these challenges.

Purpose of the Study:

  • To evaluate the effectiveness of on-table endoscopy as a quality assurance tool in laparoscopic fundoplication.
  • To compare the incidence of dysphagia and need for reintervention between patients with and without on-table endoscopy.

Main Methods:

  • A prospective study comparing 80 patients undergoing laparoscopic Rosetti-Nissen fundoplication with on-table endoscopy (group 2) to 100 prior cases without (group 1).

Related Experiment Videos

  • Pre- and postoperative symptom scoring, complication analysis, manometry, and 24-h pH testing were performed.
  • On-table endoscopy identified technical modifications in 5% of patients.

    • Main Results:

    • On-table endoscopy significantly reduced early dysphagia (5% vs. 15%) and late dysphagia (1.5% vs. 7%).
    • The incidence of dilatations required was lower in the on-table endoscopy group (5% vs. 11%).
    • No significant differences were observed in demographics, esophagitis, pH scores, or dysmotility between groups.

    Conclusions:

    • On-table endoscopy is a valuable adjunct in laparoscopic anti-reflux surgery for quality assurance.
    • Its use is associated with a reduced incidence of dysphagia and fewer reinterventions.
    • This technique aids in minimizing complications and improving patient outcomes after fundoplication.