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Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence

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Abstract

Background

Surgical results of GERD have mainly been reported from the Western countries, with a few reports found in Japan. We examined the surgical results of laparoscopic Toupet fundoplication and clarify the characteristics of recurrent cases.

Methods

The subjects included 375 patients who underwent laparoscopic Toupet fundoplication from June 1997 to December 2016 as the initial surgery. Patient characteristics, pathophysiology, and surgical results were examined. In addition, we compared the patient characteristics and pathophysiology of recurrent cases in comparison with non-recurrent cases.

Results

Age 59 (43–70) and male 211 (56.3%). The operation time was 141 min (113–180) and intraoperative complications were found to have onset in 13 subjects (3.5%). Dysphagia after surgery was found in 18 cases (4.8%). The A factor (the degree of hiatal hernia), P factor (the degree of esophagitis), and pH < 4 holding time significantly improved after surgery compared with prior to surgery (p < 0.001 for all), while the LES lengths and abdominal LES lengths were extended (p < 0.001 for each). Recurrence was found in 48 patients (15.1%) among the 318 patients for whom we could confirm the presence or absence of recurrence. The A factor, P factor, and pH < 4 holding time prior to surgery were, respectively, higher in the recurrence group (p = 0.031, p < 0.001, p < 0.001).

Conclusions

Laparoscopic Toupet fundoplication for GERD could be performed safely, with a response rate as good as 85%. Compared with non-recurrent cases, preoperative clinical conditions such as esophageal hiatal hernia, reflux esophagitis, and acid reflux time were all advanced in recurrent cases.

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Authors and Affiliations

  1. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Nobuo Omura, Fumiaki Yano, Kazuto Tsuboi, Masato Hoshino, SeRyung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Hideyuki Kashiwagi & Katsuhiko Yanaga

Authors
  1. Nobuo Omura
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  2. Fumiaki Yano
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  3. Kazuto Tsuboi
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  4. Masato Hoshino
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  5. SeRyung Yamamoto
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  6. Shunsuke Akimoto
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  7. Takahiro Masuda
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  8. Hideyuki Kashiwagi
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  9. Katsuhiko Yanaga
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Contributions

NO analyzed data and wrote the manuscript. FY, KT, MH, S-RY, SA, TM, and HK collected data. KY critically revised the manuscript.

Corresponding author

Correspondence to Nobuo Omura.

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Ethical statement

The protocol of this study has been approved by the Jikei University School of Medicine Institutional Review Board (#28–047). All informed consent was obtained from the subjects and guardians.

Conflict of interest

Drs. Omura, Yano, Tsuboi, Hoshino, Yamamoto, Akimoto, Masuda, Kashiwagi, and Yanaga have no conflicts of interest or financial ties to disclose.

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Omura, N., Yano, F., Tsuboi, K. et al. Surgical results of laparoscopic Toupet fundoplication for gastroesophageal reflux disease with special reference to recurrence. Esophagus 15, 217–223 (2018). https://doi.org/10.1007/s10388-018-0616-x

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  • DOI: https://doi.org/10.1007/s10388-018-0616-x

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